Background

This study aimed to evaluate the impact of preoperative prostate artery embolization (PAE) on intraoperative blood loss during transurethral resection of the prostate (TURP) in glands larger than 80 cc.

Material and methods

A prospective, surgeon-blinded randomized controlled clinical trial was conducted at a single tertiary center. Patients with a prostate volume of more than 80 cc with indications for TURP were randomized (1:1) to the following groups: preoperative prostatic artery embolization followed by TURP (Group A-intervention arm) and TURP alone (Group B-control arm). The primary outcome studied was blood loss measured as the drop in hemoglobin level postoperatively, and the secondary outcome measured was resection efficiency (resected weight per min) and postoperative complication rate.

Results

Our study included 10 patients each in group, A and B. The median prostate volume was 119 mL and 140 mL and the median preoperative hemoglobin was 13.3 g/dL (interquartile range: 12.5 - 14.3 g/dL) and 14.4 g/dL (interquartile range: 10.1-15.2 g/dL) in groups A and B, respectively. Change in postoperative hemoglobin was significantly greater in Group B than in Group A (-1.4 g/dL versus +0.5 g/dL, P = 0.015). There were no significant differences in the weight of resected prostate chips (52 g versus 73 g, P = 0.089) and resection efficiency (0.7 g/min versus 0.6 g/min, P = 0.853) between groups A and B. Two patients in Group B received one unit of red blood cell transfusion compared to only 1 patient in Group A (P = 1.000). One patient from each group had to be brought back to the operation room for hemostasis.

Conclusion

Our study demonstrated that preoperative prostate artery embolization reduces intraoperative blood loss in men with large prostates undergoing TURP but did not impact resection efficiency or complication rate.

1. Blandy, J. P., Reynard, J. M., & Notley, R. (2004). Transurethral resection. CRC Press. https://doi.org/10.1201/b14348
2. Cho, J. M., Moon, K. T., Lee, J. H., Choi, J. D., Kang, J. Y., & Yoo, T. K. (2021). Open simple prostatectomy and robotic simple prostatectomy for large benign prostatic hyperplasia: Comparison of safety and efficacy. Prostate International, 9(2), 101–106. https://doi.org/10.1016/j.prnil.2020.10.002
3. Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
4. European Association of Urology. (2023). EAU guidelines. Presented at the EAU Annual Congress, Milan, Italy.
5. Franco, J. V. A., Tesolin, P., & Jung, J. H. (2023). Update on the management of benign prostatic hyperplasia and the role of minimally invasive procedures. Prostate International, 11(1), 1–7. https://doi.org/10.1016/j.prnil.2023.01.002
6. Habib, E., Abdallah, M. F., ElSheemy, M. S., Badawy, M. H., Nour, H. H., Kamal, A. M., & El-Nahas, A. R. (2022). Holmium laser enucleation versus bipolar resection in the management of large-volume benign prostatic hyperplasia: A randomized controlled trial. International Journal of Urology, 29(2), 128–135. https://doi.org/10.1111/iju.14737
7. Jones, P., Rai, B. P., Nair, R., & Somani, B. K. (2015). Current status of prostate artery embolization for lower urinary tract symptoms: Review of world literature. Urology, 86(4), 676–681. https://doi.org/10.1016/j.urology.2015.07.010
8. Kam, S. C., Park, J. W., Kim, M. K., Kim, K. Y., Lee, K. S., Kim, T. H., & Lee, H. N. (2022). Robotic-assisted simple prostatectomy after prostatic arterial embolization for large benign prostate hyperplasia: Initial experience. Prostate International, 10(3), 148–151. https://doi.org/10.1016/j.prnil.2022.03.004
9. Knight, G. M., Talwar, A., Salem, R., & Mouli, S. (2021). Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovascular and Interventional Radiology, 44(2), 183–193. https://doi.org/10.1007/s00270-020-02657-6
10. Kuang, M., Vu, A., & Athreya, S. (2017). A systematic review of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia. Cardiovascular and Interventional Radiology, 40(5), 655–663. https://doi.org/10.1007/s00270-016-1539-3
11. Mebust, W. K., Holtgrewe, H. L., Cockett, A. T., & Peters, P. C. (2002). Transurethral prostatectomy: Immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. The Journal of Urology, 167(2 Pt 2), 999–1003. https://doi.org/10.1016/S0022-5347(02)80323-8
12. Song, B., Song, S. H., & Jeong, S. J. (2023). Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia. Prostate International, 11(4), 204–211. https://doi.org/10.1016/j.prnil.2023.08.002
13. Somwaru, A. S., Metting, S., Flisnik, L. M., Nellamattathil, M. G., Sharma, A., & Katabathina, V. S. (2020). Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia. BMC Urology, 20(1), Article 159. https://doi.org/10.1186/s12894-020-00726-y
14. Uflacker, A., Haskal, Z. J., Bilhim, T., Patrie, J., Huber, T., & Pisco, J. M. (2016). Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. Journal of Vascular and Interventional Radiology, 27(11), 1686–1697.e8. https://doi.org/10.1016/j.jvir.2016.08.007