N-butyl cyanoacrylate glue application in prostate artery embolization for benign prostatic hyperplasia: a systematic review of safety and efficacy.

backgroundBenign prostatic hyperplasia (BPH) is the most common urological disorder in older males, often treated with prostate artery embolization (PAE) to alleviate lower urinary tract symptoms. While traditional embolic materials like microspheres are common, issues such as symptom recurrence and non-target embolization remain. This systematic review evaluates the safety and effectiveness of n-butyl cyanoacrylate (NBCA) glue as an alternative embolic agent for PAE. MATERIALS AND

methodsA thorough search was performed across databases including PubMed, ScienceDirect, Cochrane, Google Scholar, Scopus, and MEDLINE. Studies were included if they assessed NBCA glue for PAE in BPH patients. Exclusions were made for reviews, non-English articles, conference abstracts, and studies not using glue or ethiodized oil mixtures. The Methodological Index for Non-Randomized Studies criteria was used to assess bias risk, and due to varied outcome measures, a narrative synthesis was conducted.

resultsSix studies involving 667 patients met the inclusion criteria. The age in mean ± SD across studies ranged from 67.5 ± 7.8 to 72.6 ± 10.5 with most patients presenting with moderate to severe BPH unresponsive to medication. NBCA glue-based procedures showed high technical success rates and shorter procedure times. International Prostate Symptom Score improvement was reported in 83-94% of patients across all studies with associated quality of life significantly enhanced in up to 94% of patients as well. Prostate volume reduction ranged from 11% to 40.5%, depending on follow-up duration. PSA levels and medication use decreased, and erectile function was mostly preserved, though results varied. Minor complications like groin hematomas and post-embolization syndrome occurred in 4-22% of patients, with no major adverse events reported.

conclusionThis review assesses NBCA-based glue as a potential embolic agent in PAE for BPH. The evidence suggests promising short-term outcomes with a favorable safety profile, though findings remain preliminary due to small sample sizes and short follow-up. Larger multicenter randomized trials are therefore needed to validate these results and guide clinical practice.