What PAE Does

PAE is performed by an interventional radiologist, not a urologist. Through a small puncture in the wrist or groin, the radiologist passes a catheter to the prostatic arteries and injects microspheres that reduce blood flow to the prostate, causing it to shrink over several weeks. This minimally invasive PAE treatment for enlarged prostate can help relieve urinary symptoms. PAE does not require general anesthesia in most centers, and most patients are discharged within 24 hours. It preserves ejaculatory function, which TURP does not reliably preserve in all patients.

What TURP Does

TURP removes the obstructing prostate tissue directly using an electrical or laser resection loop passed through the urethra. Symptom improvement is typically rapid, occurring within days to weeks of the procedure. TURP is performed under spinal or general anesthesia and requires a hospital stay of one to three days. The long-term efficacy data for TURP extends over four decades, making it the most evidence-supported surgical intervention for BPH.

What the Research Shows

According to Cardiovascular and Interventional Radiology PAE vs TURP Meta-Analysis, PAE produces symptom improvement in 80 to 90 percent of patients, with symptom scores and urinary flow rates improving significantly. TURP produces more complete and more rapid improvement in urinary flow rates compared to PAE, and TURP has lower rates of retreatment at five-year follow-up. PAE has lower rates of ejaculatory dysfunction and retrograde ejaculation compared to TURP.

When to Consider Which

Consider PAE when: the patient is not an appropriate surgical candidate due to anesthesia risk or anticoagulation therapy; preserving ejaculatory function is a high priority; and the patient is willing to accept a potentially higher retreatment rate in exchange for lower procedural invasiveness.

Consider TURP when: complete and durable symptomatic relief is the primary goal; the patient is an appropriate surgical candidate; and long-term retreatment rates are the priority concern. The right choice depends on individual circumstances that require discussion with both a urologist and an interventional radiologist familiar with both procedures.