Comparison of the efficacy and safety of holmium laser enucleation of the prostate and prostate artery embolization: Short-term follow-up results

Abstract

Purpose

The treatment options for benign prostatic hyperplasia vary. Holmium laser enucleation of the prostate (HoLEP) and prostate artery embolization (PAE) have emerged as novel surgical treatments for benign prostatic hyperplasia. However, limited comparative evidence exists between these two techniques. Thus, we investigated their efficacy and adverse events with a short-term follow-up.

Materials and methods

This prospective study reviewed the medical records of 329 patients who underwent HoLEP (n = 249) or PAE (n = 80). The International Prostate Symptom Score (IPSS), IPSS Quality of Life (QoL), maximal flow rate (MFR), and post-void residual urine (PVR) were measured to assess efficacy. For adverse events, the International Index of Erectile Function-5 (IIEF-5), the Male Sexual Health Questionnaire (MSHQ)-Short Form, and procedure-related complications were evaluated. All variables were compared within and between the two treatments at baseline and 1 and 3 months after the procedure.

Results

A total of 108 patients were matched for each group and baseline characteristics were balanced between the groups. The IPSS, IPSS QoL, MFR, and PVR improved following each procedure. However, compared with PAE, HoLEP achieved greater improvements in the IPSS, IPSS QoL, MFR, and PVR from baseline to 3 months (all P < 0.05). In terms of sexual function, PAE better preserved both erectile (P = 0.001) and ejaculatory (P = 0.001) function compared with HoLEP over the same period. The overall incidence of adverse events was higher with HoLEP (28.1%) than with PAE (10%) (relative risk 3.19; 95% confidence interval 1.61–6.34, P = 0.009). One case of penile glans necrosis, a unique adverse event, was observed following PAE.

Conclusions

In the short term, HoLEP and PAE can significantly improve lower urinary tract symptoms. However, compared with PAE, HoLEP provides superior efficacy yet is associated with less preservation of sexual function and a higher rate of adverse events.