Comparison of Perioperative Outcomes for Prostate Artery Embolization Versus Transurethral Resection of the Prostate and Laser Enucleation for Benign Prostatic Hyperplasia: Results from the GRAND Study

<b>Background/Objectives:</b> Prostate artery embolization (PAE) has emerged as a relatively new, minimally invasive alternative for the treatment of benign prostatic hyperplasia. We aimed to compare the perioperative outcomes and trends of PAE versus transurethral resection of the prostate (TURP) and laser enucleation. <b>Materials and Methods:</b> We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics, and performed multiple patient-level analyses. Patients with prostate cancer, acute hematuria, and emergent referral to the hospital were excluded. <b>Results:</b> Between 2017 and 2022, a total of 3665 PAEs were performed in Germany compared to 218,388 TURPs and 50,863 laser enucleations. Patients selected for PAE were slightly younger and presented with fewer comorbidities at baseline. The number of laser enucleations increased exponentially in these years, PAEs remained stable, whereas TURPs slightly decreased. Compared to PAE, laser enucleation was associated with higher odds of in-hospital incontinence (4.2% versus 2.7%, OR: 1.6, 95%CI: 1.3-1.9, <i>p</i> < 0.001). On the contrary, PAE was associated with lower odds of in-hospital urinary retention and shorter length of hospital stay compared to TURP (3.2% versus 7.1%, OR: 2.2, 95%CI: 1.8-2.6, <i>p</i> < 0.001, and a 2.6-day difference, 95%CI: 2.5-2.7, <i>p</i> < 0.001, respectively) and laser enucleation (3.2% versus 5%, OR: 1.5, 95%CI: 1.3-1.8, <i>p</i> < 0.001, and a 1.5-day difference, 95%CI: 1.4-1.6, <i>p</i> < 0.001, respectively). <b>Conclusions:</b> PAE offers more favorable perioperative outcomes compared to TURP and laser enucleation, but the use of this relatively new procedure has remained nearly stable in recent years.