If you are experiencing complete urinary retention (inability to empty the bladder), fever/chills, heavy bleeding, or severe pain, contact emergency or urgent care immediately.

Key facts

  • At 12 weeks in one trial, symptom scores fell 9.23 points after PAE and 10.77 after TURP. Urine flow improved 5.19 mL/s after PAE and 15.34 mL/s after TURP.
  • That trial recorded 36 side-effect events after PAE and 70 after TURP.
  • Ejaculation problems were 56% after PAE and 84% after TURP among men who could be assessed. After PAE, the most common change was reduced ejaculation (40%). No ejaculation at all was 16% after PAE and 52% after TURP.
  • At 2 years, 10 men who had PAE (21%) went on to TURP. Another trial at 12 months found a larger symptom drop after PAE than after TURP.
  • PAE is often same-day. A TURP hospital stay is typically 1 to 4 days, and the catheter is usually removed about 1 to 3 days after TURP.

Who does each procedure

A urologist is a surgeon who treats the prostate from inside the urine channel. That can include TURP, HoLEP, laser surgery, or smaller office treatments such as UroLift and Rezum. An interventional radiologist does PAE. They use X-ray pictures and a thin tube in a blood vessel, usually at the wrist or groin, to slow blood flow to parts of the prostate. The prostate then shrinks over time. It's worth discussing PAE with both a urologist and an interventional radiologist.

Questions for your Urologist

  • Which procedures fit my prostate size, including the middle part if it sticks into the bladder?
  • If I choose surgery, how long do the results usually last compared with an office procedure?
  • Do you think PAE is reasonable to discuss for my symptoms, or should I stay with urology options?

Questions for your Interventional Radiologist

  • Looking at my pictures, can you safely reach the blood vessels to the prostate?
  • How often are you able to treat both sides in men like me?
  • Should I finish a urology visit, including a look inside the bladder if you think I need it, before we schedule PAE?

How the procedures are different

Surgery works from the inside. The doctor removes or trims prostate tissue that is squeezing the urine channel. The stream often improves right away, and that channel needs time to heal. PAE does not cut the channel. Tiny particles slow the blood supply, and the prostate softens and shrinks over a few months. The amount varies, and symptom relief does not depend only on how much it shrinks1,2.

Questions to ask

  • How soon might my stream and night waking improve with surgery, and how soon with PAE?
  • If my prostate is very large, over about 80 or 100 cc, which option is more often discussed?
  • If I already need a catheter because I cannot pee, what is the chance I can pee without it after PAE, and after surgery?

Recovery and catheters

PAE is done under local anesthesia, while TURP needs spinal or general anesthesia3. PAE is often same-day4,5. A TURP hospital stay is typically 1 to 4 days6. The catheter is usually removed about 1 to 3 days after TURP, before you go home. Sometimes you go home with a catheter for a few more days if you can't pee yet7,8. Your plan can still be different.

Questions to ask

  • What kind of anesthesia would I need, and how does that fit my heart and lung health?
  • Will I stay overnight, and how many days might I have a catheter at home?
  • When could I drive, lift, and go back to work?

Side effects to ask about

In the Abt trial, ejaculation problems affected 56% of men after PAE (14 of 25) and 84% after TURP (21 of 25), counting only men whose ejaculation could be assessed3. No ejaculation at all happened in 16% after PAE and 52% after TURP. After PAE the most common change was reduced ejaculation, in 40%9. Late complications of TURP include urethral stricture (about 2 to 10%) and bladder neck contracture (about 0.3 to 9%). Temporary urge leakage is common early on (up to 30 to 40%), but long-term stress incontinence is rare (less than 0.5%)10. Ask your surgeon what they expect for you.

PAE avoids cutting inside the urethra, and ejaculatory side effects appear less common than after TURP. Risks include blood in the urine or semen, painful or frequent urination, temporary difficulty urinating, urinary infection, bruising or bleeding at the puncture site, contrast and radiation exposure, and rarely, blocked blood flow to nearby organs such as the bladder, rectum, or penis. In some patients the arteries cannot be treated on one or both sides.

At 12 weeks in the Abt trial, symptom scores fell by an average of 9.23 points after PAE and 10.77 points after TURP. Peak urine flow improved by 5.19 mL/s after PAE and 15.34 mL/s after TURP. PAE had fewer side effects and complications: 36 events versus 70. The trial could not show that PAE was as good as TURP within the margin the researchers set, although the symptom-score difference was not statistically significant3.

At 2 years in the same trial, symptom scores had fallen by 9.21 points after PAE and 12.09 points after TURP, which favored TURP. Peak urine flow had improved by 3.9 mL/s after PAE and 10.23 mL/s after TURP. Ten of the men who had PAE (21%) went on to need TURP within 2 years because their results were not satisfying11.

Trials do not all point the same way. In Insausti et al., symptom scores fell by 21.0 points after PAE and 18.2 points after TURP at 12 months. Peak urine flow rose by 6.1 mL/s after PAE and 9.6 mL/s after TURP. PAE had fewer side effects (15 versus 47) and a greater improvement in quality of life12.

In randomized trials, symptom improvement after PAE was close to TURP, but flow rate and emptying improved less, and side effects were fewer. A study that compared PAE with a pretend procedure showed PAE works better than that pretend procedure at 6 months. In that trial, symptom scores improved by 13.2 more points with PAE than with the pretend procedure2. Long-term comparisons are limited.

Questions to ask

  • For the surgery you suggest, how often do men have reduced ejaculation, no ejaculation, or trouble with erections?
  • How often do men have scarring or lasting trouble holding urine with each option?
  • How often do symptoms come back enough that men need another procedure, or go back on medicine, within 3 to 5 years?

Recovery details are on the PAE recovery guide. Coverage questions are on PAE Medicare coverage. Bring questions to ask before PAE, and talk with your doctor. More enlarged-prostate topics are in the BPH article library and on the BPH treatment options page.

Common questions

Is prostate artery embolization safer than TURP?

Neither one is simply safer. They have different risks. At 12 weeks in one trial, urine flow improved more after TURP, and PAE had fewer side-effect events (36 versus 70). Ejaculation problems were less common after PAE. Ask both a urologist and an interventional radiologist which risks matter for you.

How is PAE different from TURP?

Surgery removes or trims prostate tissue that is squeezing the urine channel, so the stream often improves right away. PAE does not cut the channel. Tiny particles slow the blood supply, and the prostate softens and shrinks over a few months. The amount varies, and symptom relief does not depend only on how much it shrinks.

Will I need a catheter after PAE or TURP?

The catheter is usually removed about 1 to 3 days after TURP, before you go home. Sometimes you go home with a catheter for a few more days if you can't pee yet. PAE is often same-day. A TURP hospital stay is typically 1 to 4 days. If you already need a catheter because you cannot pee, ask when your team will try removing it. Your plan can still be different.

How do sexual side effects compare after PAE and TURP?

In one trial, ejaculation problems affected 56% of men after PAE (14 of 25) and 84% after TURP (21 of 25), counting only men whose ejaculation could be assessed. No ejaculation at all happened in 16% after PAE and 52% after TURP. After PAE the most common change was reduced ejaculation, in 40%. PAE avoids cutting inside the urethra, and ejaculatory side effects appear less common than after TURP.

Does PAE work as well as TURP?

At 12 weeks in one trial, symptom scores fell by 9.23 points after PAE and 10.77 points after TURP. Peak urine flow improved by 5.19 mL/s after PAE and 15.34 mL/s after TURP. The trial could not show PAE was as good as TURP within the researchers' set margin, even though the symptom-score difference was not statistically significant. At 2 years, 10 men who had PAE (21%) went on to need TURP. A study that compared PAE with a pretend procedure showed PAE works better than that pretend procedure at 6 months.

Who should I talk with before choosing PAE or surgery?

It's worth discussing PAE with both a urologist and an interventional radiologist. A urologist treats the prostate from inside the urine channel. An interventional radiologist does PAE. This page does not tell you which one to choose.

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Sources

  1. Abt et al., BMJ 2018 (PMID 29921613) ↩︎
  2. Pisco et al., European Urology 2020 (PMID 31831295) ↩︎
  3. Abt et al., BMJ 2018 ↩︎
  4. PAE day-case leaflet ↩︎
  5. PAE patient leaflet, 2024 ↩︎
  6. TURP overview ↩︎
  7. TURP patient information ↩︎
  8. TURP recovery information ↩︎
  9. Ejaculation outcomes after PAE and TURP, 2020 ↩︎
  10. Rassweiler et al., European Urology 2006 ↩︎
  11. Abt et al., 2-year results ↩︎
  12. Insausti et al., JVIR 2020 (PMID 32249193) ↩︎
  13. AUA BPH guideline
  14. SIR multisociety PAE statement, JVIR 2019 (PMID 30926185)