26 - Safety and Efficacy of Prostatic Artery Embolization with Cyanoacrylate Glue for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis of Short-term Outcomes

Purpose: Cyanoacrylate glue is an alternative to conventional embolic agents used for Prostatic Artery Embolization (PAE), such as microparticles. However, its therapeutic potential in the treatment of symptomatic Benign Prostatic Hyperplasia (BPH) remains underexplored. This study aims to update and reinforce the current evidence regarding the safety and efficacy of PAE performed with glue in this clinical context, enabling future comparisons between different PAE techniques and contributing to the identification of the most appropriate.

Materials and Methods: A systematic review and single-arm meta-analysis was conducted by searching PubMed, Embase, and CENTRAL for studies involving PAE with cyanoacrylate glue in patients with Lower Urinary Tract Symptoms (LUTS) secondary to BPH. Primary outcomes included the International Prostate Symptom Score (IPSS), Prostate Volume (PV), and Quality of Life (QoL). Procedural technical aspects were also assessed. A subset analysis was performed for outcomes reported within three months of follow-up, and sensitivity tests were conducted in cases of high heterogeneity. All statistical analyses were performed using RStudio.

Results: Six retrospective studies were included, comprising 490 patients with a mean age of 70.25 ± 8.11 years. Follow-up periods ranged from 7.1 weeks to 6 months. Technical success was achieved in 97% of cases. At the end of follow-up, significant improvements were observed in IPSS (MD -12.52; 95%CI [-15.87 to -9.17]; I² = 95.1%), QoL (MD -2.71; 95%CI [-3.09 to -2.33]; I² = 65.8%) and PV (MD -28.77; 95%CI [-34.73 to -22.81]; I² = 12.4%). Subset analysis within three months also revealed substantial gains in IPSS (MD -10.51; 95%CI [-11.41 to -9.61]; I² = 0%), QoL (MD -2.39; 95%CI [-2.71 to -2.07]; I² = 60.2%) and PV (MD -16.75; 95%CI [-25.29 to -8.21]; I² = 34.1%). PAE with glue demonstrated consistent short-term efficacy and further improvement over time. Sensitivity analysis suggested that high heterogeneity may be associated with baseline differences in PV across studies. No heterogeneity (I² = 0%) was observed regarding the type of cyanoacrylate glue. Compared to microparticles, cyanoacrylate glue appears to confer technical advantages, while providing similarly effective outcomes.

Conclusion: PAE with cyanoacrylate glue is safe and effective for alleviating symptoms of BPH, offering outcomes comparable to microparticles. Nonetheless, further randomized controlled trials with longer follow-up are warranted to expand and strengthen these findings.