Comparison
Prostate artery embolization (PAE) vs TURP: fewer side effects, or stronger relief of blockage
In the main trial, PAE had fewer adverse events, a shorter hospital stay and fewer ejaculation problems than TURP. TURP improved urine flow more, and fewer men needed another procedure. This page lists what the trials and guidelines say so you can talk it over with your doctor.
What the studies and guidelines say
| Prostate artery embolization (PAE) | TURP | Sources | |
|---|---|---|---|
| What it is | A thin tube is passed through an artery at the top of the leg to the arteries that feed the prostate. Tiny beads cut the blood supply so part of the prostate shrinks. | A scope is passed through the urethra, with no skin cut, and the prostate tissue blocking urine flow is cut away. | [1] [8] [9] |
| Anesthesia and setting | Local numbing medicine. NICE notes it avoids a general anesthetic. | Spinal or general anesthesia. | [1] [8] [9] |
| Hospital stay | Abt trial (Switzerland): 2.2 days on average, with a bladder catheter for 1.3 days. UK registry: 71% were outpatient or day cases. | Abt trial: 4.2 days on average, with a catheter for 3.3 days. The NHS says 1 to 4 days. | [1] [5] [9] |
| Recovery | Days to normal activity: not confirmed in the sources we read. NICE says pelvic pain usually lasts no more than 1 to 3 days. | The NHS says usual activities at about 2 to 4 weeks. | [8] [9] |
| Symptom relief | Symptom score fell 9.2 points at 12 weeks and 9.2 points at 2 years. Urine flow rose 5.2 mL per second. | Symptom score fell 10.8 points at 12 weeks and 12.1 points at 2 years, more than with PAE. Urine flow rose 15.3 mL per second. | [1] [2] [3] |
| Another procedure later | Abt trial: 21% had TURP within 2 years. A Cochrane review found re-treatment is likely about 3 times more common than after TURP. | A national study cited by the EAU found a repeat TURP in 6.1% at 5 years. | [2] [6] [7] |
| Main risks | Abt trial: 36 adverse events in 12 weeks, versus 70 after TURP. Pain right after the procedure was more common (56.3% versus 31.9%). | Abt trial: more adverse events and more blood loss. The NHS lists heavy bleeding, loss of bladder control, erection problems and no semen on ejaculation. | [1] [9] |
| Prostate and sexual function | The prostate is kept. Ejaculation problems in 56% of men assessed, with no ejaculate in 16%. Erection scores matched TURP. | Part of the prostate is removed. Ejaculation problems in 84% of men assessed, with no ejaculate in 52%. | [1] [4] |
| What guidelines say | EAU (2026): a weak recommendation to offer PAE to men who want a less invasive option and accept less-optimal results than TURP. NICE (2018): evidence is adequate to support its use. | EAU (2026): a strong recommendation to offer TURP for prostates of 30 to 80 mL, where it is the standard surgical procedure. | [7] [8] |
| Who was studied | Men 40 and older with prostates of 25 to 80 mL and symptoms not controlled by medicine. | The same men. The trial authors said TURP should be preferred when the enlarged prostate has caused problems such as repeated urinary retention or bladder stones. | [1] |
Sources, checked November 11, 2026. Numbers in the last column point to this list.
- Abt et al. PAE versus TURP: randomised, open label, non-inferiority trial. BMJ 2018
- Abt et al. PAE versus TURP: 2-year outcomes. Eur Urol 2021
- Muellhaupt et al. PAE versus TURP: 5-year outcomes. Eur Urol Focus 2024
- Muellhaupt et al. Ejaculatory disorders after prostatic artery embolization. World J Urol 2020
- Ray et al. UK-ROPE study: PAE and matched comparison with TURP. BJU Int 2018
- Jung et al. Prostatic arterial embolization for benign prostatic hyperplasia. Cochrane Database Syst Rev 2022
- European Association of Urology: Management of Non-Neurogenic Male LUTS guideline (2026)
- NICE HTG469: Prostate artery embolisation for benign prostatic hyperplasia (2018)
- NHS: Transurethral resection of the prostate (TURP)
Why people choose one or the other
Why some people choose PAE
- They want a less invasive option without a general anesthetic.
- Keeping ejaculation matters to them.
- They accept less improvement in urine flow and a higher chance of needing another procedure.
Why some people choose TURP
- They want the larger improvement in urine flow and bladder emptying.
- They want a lower chance of needing another procedure.
- The enlarged prostate has caused problems such as repeated urinary retention or bladder stones.
What this evidence can and cannot tell you
Most numbers here come from one trial of 103 men at a single hospital in Switzerland. Hospital stays there may differ from care near you; a UK registry reported most PAE cases as day cases. At 5 years the gap in symptom scores was no longer statistically significant, but fewer than half of the PAE group reached that visit.
We could not read the 2026 American Urological Association guideline, which sits behind a login, so it is not summarized here. A urologist and an interventional radiologist together can tell you which options fit your prostate.
Common questions
Is PAE as effective as TURP?
In the main randomized trial, symptoms improved by a similar amount at 12 weeks (9.2 versus 10.8 points). TURP gave a much larger gain in urine flow and bladder emptying, and by 2 years the symptom improvement was larger with TURP.
Will I need another procedure after PAE?
In the Abt trial, 21% of men who had PAE went on to TURP within 2 years, and a UK registry found a 20% re-operation rate. For TURP, a national study cited by the European Association of Urology found a repeat TURP in 6.1% by 5 years.
Does PAE affect ejaculation or erections?
In the Abt trial, ejaculation problems were reported after both treatments but less often after PAE (56% versus 84%). Complete loss of ejaculate was 16% after PAE and 52% after TURP. Erection scores were similar in both groups.
How long is the hospital stay, and will I have a catheter?
In the Abt trial in Switzerland, the average stay was 2.2 days after PAE and 4.2 days after TURP, with a catheter for 1.3 and 3.3 days. In a UK registry, 71% of PAE cases were done as outpatient or day cases.
What are the risks of PAE?
The Abt trial recorded about half as many adverse events after PAE as after TURP in the first 12 weeks. Pain right after the procedure was more common after PAE.
See prices, devices and anatomy
TURP: typical price How PAE is done Embolic beads used Pelvic artery anatomy
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For education only, not medical advice. This page summarizes published studies and guidelines and does not recommend a treatment. Trial results come from specific groups of patients and may not match your situation. Talk with your own doctor.