Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study.

Autor: Raizenne BL; Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada., Zheng X; Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA., Oumedjbeur K; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada., Mao J; Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA., Zorn KC; Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada., Elterman D; Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada., Bhojani N; Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada., McClure T; Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA., Te A; Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA., Kaplan S; Department of Urology, Mount Sinai Hospital, New York, NY, USA., Sedrakyan A; Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA., Chughtai B; Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA. bic9008@med.cornell.edu.; Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA. bic9008@med.cornell.edu.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Jan; Vol. 41 (1), pp. 179-188. Date of Electronic Publication: 2022 Dec 04.
DOI: 10.1007/s00345-022-04218-6
Abstrakt: Background: There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH.
Methods: We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ 2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan-Meier failure curves and compared them using Log rank tests and Cox regression models.
Results: Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2 years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7-34.2%) compared to TURP (3.4% (95%CI 3.1-3.8%)) and PUL (8.5% (95%CI 5.6-12.9%)) (p < 0.001).
Conclusion: In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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