攝護腺肥大的標準手術治療一直是經尿道攝護腺刮除手術，雖然這是一項成熟且安全的手術，但一些共病較多的人仍然必須承擔手術帶來的風險。隨著血管攝影及導管技術的進步，放射科醫師漸漸嘗試透過栓塞攝護腺血管來使其壞死萎縮，治療攝護腺肥大。這項治療雖然看似微創、病人可以在局部麻醉下進行、並且不需在治療前停止抗凝血劑，但是許多研究報告指出栓塞後的攝護腺壞死過程可能帶來許多問題，包括一段時間攝護腺發炎腫脹帶來的疼痛及尿滯留、凋落的壞死組織阻塞…等。並且目前缺乏大型且證據力強的研究來支持，攝護腺栓塞的效果是否如同標準的手術治療這麼好。這篇研究難能可貴的地方在於，它使用證據等級最高的隨機分派試驗來比較攝護腺栓塞及標準手術（經尿道攝護腺刮除手術）的術後效果，並且在術後追蹤了長達兩年時間！！因此是一篇非常具有代表性的研究，難怪發表於如此高分期刊～

這篇研究最主要的結果告訴我們：在兩年追蹤期間，各項排尿指標皆是標準手術治療優於攝護腺栓塞。包括最大尿流速及殘尿量的改善、病人自覺排尿症狀(IPSS)及生活品質分數改善。甚至在接受攝護腺栓塞的病人中，有21%病人後續仍然接受了手術治療。

雖然攝護腺栓塞手術的治療效果不如預期，但它的確有較少的術後併發症。
特別是在輕度併發症明顯較少，在較嚴重的併發症上兩種治療則沒有明顯差異。

總結來說，攝護腺栓塞的確提供一些本身疾病非常嚴重、麻醉風險太高的病人新的治療選擇。但是有鑒於栓塞後的效果與手術治療的差距仍舊明顯，且根據本研究有五分之一病人後續仍須接受手術。因此仍建議以標準的攝護腺刮除手術，做為攝護腺肥大進階治療的首選。

Background: Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation.

Objective: To compare the efficacy and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up. Design, setting, and participants: A randomised, open-label trial was conducted. There were 103 participants aged 40 yr with refractory LUTS/BPO. Intervention: PAE versus TURP. Outcome measurements and statistical analysis: International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests.

Results and limitations: The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 [95% confidence interval 0.04–5.72]; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of –6.33 [–10.12 to –2.54]; p < 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 [43.31–240.51]; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 [7.70–31.38]; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfy-ing clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study.

Conclusions: Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be consid-ered for patient selection and counselling.