Prostate artery embolization assessed in Swedish South East healthcare region

In Sweden, the County Councils are grouped into six healthcare regions to facilitate cooperation and to maintain a high level of advanced medical care. One of them is the Regional Methods Council of South East healthcare region. This Council provides support for decision-making in the South East healthcare region and evaluates the scientific evidence for the introduction of new medical practices and devices in the South East healthcare region. Medicines are excluded from the scope of the assessment of the Council.

In September 2019, Regional Methods Council of South East healthcare region released a report for prostate artery embolization (PAE) for benign prostatic hyperplasia, which aimed to assess PAE in comparison to transurethral resection of the prostate (TURP) in terms of efficiency and cost-effectiveness. The Council came to the following conclusions:

• The PAE could be performed in day surgery with the use of local anesthesia and anticoagulation treatment, whereas TURP requires hospitalization, spinal anesthesia and, in some cases, heparin injections for a period
• Few cases of urinary incontinence and retrograde ejaculation have been reported after PAE
• The need for blood transfusions is lower for PAE than TURP
• The costs for PAE are lower than for TURP
• The PAE is primarily relevant for the following groups of patients:
  • Elderly patients with comorbidities, when spinal or general anesthesia can not be used
  • Patients with prostate glands larger than 80 mL
• The following disadvantages of PAE were determined:
  • The PAE is a technically demanding intervention with the use of X-rays and contrast agents
  • The risk of inadvertent embolization of adjacent arteries/organs
  • Possible injury of the femoral artery in the groin in the form of bleeding or clot formation
  • Aneurysm occurrence at the site of puncture
• The following prerequisites for the introduction of PAE into the practice were outlined:
  • The good skills and interventions of radiologists
  • Well-established center
  • The operation should take place in cooperation with the urological department
• The use of registries for follow-up of patients and registration of side effects is strongly recommended.

See the full information in Swedish here.

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