Preoperative prostatic artery embolization before transurethral resection of the prostate for prostate glands larger than 80 mL: the first randomized controlled trial

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.