Comparing PAE and TURP for BPH: What You Need to Know
Benign Prostatic Hyperplasia (BPH), or an enlarged prostate, affects more than 50% of men over 50 and up to 90% of men over 80. It can cause frustrating urinary symptoms such as frequent urination, difficulty starting, weak stream, and nocturia (waking at night to urinate). For patients whose symptoms no longer respond to medications, two of the most recommended procedures are: Transurethral Resection of the Prostate (TURP) and Prostatic Artery Embolization (PAE).
While both procedures aim to relieve urinary symptoms and improve quality of life, they differ in approach, invasiveness, recovery time, and potential side effects.
What Is TURP?
TURP is considered the gold standard surgical treatment for BPH. During TURP, a surgeon inserts a scope through the urethra and uses a special instrument to trim away excess prostate tissue that’s blocking urine flow.
Pros of TURP:
- Long track record of effectiveness
- Immediate symptom relief
- Covered widely by insurance
Cons of TURP:
- Requires general or spinal anesthesia
- Hospital stay of 1–2 days
- Catheter typically needed for 1–3 days post-op
- Higher risk of complications like bleeding, retrograde ejaculation, erectile dysfunction, and incontinence.¹
What Is PAE?
PAE is a minimally invasive, image-guided procedure performed by an interventional radiologist. A catheter is threaded through an artery (typically in the groin or wrist), and tiny particles are injected to block the blood supply to specific parts of the prostate. Over time, the prostate shrinks, relieving urinary symptoms.
Pros of PAE:
- Outpatient procedure with no general anesthesia
- Minimal blood loss
- Lower risk of sexual side effects
- Quicker recovery.²
Cons of PAE:
- Slightly slower onset of symptom relief
- Not suitable for all prostate anatomies
- Availability depends on specialized centers and expertise.
| Feature | PAE | TURP |
|---|---|---|
|
Type of Procedure |
Minimally invasive |
Surgical |
|
Anesthesia |
Local with sedation |
Spinal or general |
|
Hospital Stay |
Outpatient |
1–2 days |
|
Catheter Duration |
Often same-day removal or next day |
1–3 days |
|
Recovery Time |
3–5 days |
2–3 weeks |
|
Effectiveness |
75–85% symptom improvement |
80–90% symptom improvement |
|
Impact on Sexual Function |
Very low risk of retrograde ejaculation or ED |
65–75% report retrograde ejaculation |
|
Durability of Results |
Effective up to 3–5 years. |
Effective up to 10 years or more. |
What Does the Research Say?
In a 2022 randomized controlled trial published in European Urology, PAE was found to have comparable effectiveness to TURP in improving urinary symptoms, with fewer adverse events and a shorter recovery. Another study in Cardiovascular and Interventional Radiology found that PAE significantly preserved sexual function compared to TURP, a major concern for many men.
While TURP may still be slightly more effective in shrinking the prostate and relieving symptoms, the difference may not outweigh the benefits of a less invasive option like PAE—especially for patients prioritizing sexual function and a shorter recovery.
Patient Experience and Quality of Life?
For many men, especially those with other health conditions or who want to avoid surgery, PAE is a compelling choice. Patients often return to light activities within days and experience fewer urinary complications in the early post-procedure period.
That said, TURP remains a time-tested and effective treatment, especially for men with very large prostates or complex urinary anatomy. A consultation with a prostate specialist can help determine which approach is best tailored to your needs.
Why Choose CVI Prostate Center?
At CVI Prostate Center, we specialize in minimally invasive, image-guided therapies for prostate conditions, including Prostatic Artery Embolization. Our state-of-the-art facility in Southern California offers a patient-centered environment, where safety, comfort, and innovation are top priorities.
Our lead interventional radiologist, Dr. Allaei, is nationally recognized for his expertise in prostate artery embolization. With more than a decade of experience performing PAE, Dr. Allaei has helped hundreds of men achieve relief from BPH symptoms without surgery, without sacrificing quality of life, and often without even needing general anesthesia.
At CVI Prostate Center, you’ll benefit from personalized care, advanced imaging technology, and the highest standards of interventional radiology.
Making the Right Decision for You
Choosing between PAE and TURP depends on your symptoms, prostate size, general health, and personal preferences. If avoiding surgery, preserving sexual function, and recovering quickly are your top priorities, PAE may be the ideal choice. If you’re seeking the most durable long-term symptom relief and are comfortable with a more invasive procedure, TURP might be more appropriate.
At CVI Prostate Center, we’re here to help guide you through that decision with compassion, clarity, and clinical excellence.
1.) Rassweiler, J. et al. (2006). “Transurethral resection of the prostate: still gold standard?” Journal of Endourology, 20(10), 857–861.
2.) Carnevale, F.C. et al. (2016). “Prostatic artery embolization for benign prostatic hyperplasia: a prospective single-center, randomized, comparative study.” Journal of Vascular and Interventional Radiology, 27(8), 1143–1150.
3.) Bagla, S. et al. (2014). “Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia.” Journal of Vascular and Interventional Radiology, 25(1), 47–52.
4.) Reich, O. et al. (2008). “The TURP syndrome—myth or reality?” Journal of Endourology, 22(6), 1273–1279.
5.) Ray, A.F. et al. (2018). “Sexual function after prostatic artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis.” Cardiovascular and Interventional Radiology, 41(9), 1343–1353.
6.) Rassweiler, J. et al. (2006). “Transurethral resection of the prostate: still gold standard?” Journal of Endourology, 20(10), 857–861.
7.) Pisco, J.M. et al. (2017). “Five-year follow-up of 630 patients treated with PAE for BPH.” Journal of Vascular and Interventional Radiology, 28(5), 805–812.
8.) Madersbacher, S. et al. (1994). “Long-term outcome of transurethral resection of the prostate.” European Urology, 26(4), 239–245.
9.) Abt, D. et al. (2022). “PAE versus TURP for BPH: a randomized controlled trial.” European Urology, 82(5), 475–483.
10.) Gao, Y. et al. (2014). “Comparative study of the effect of PAE and TURP on sexual function in patients with BPH.” Cardiovascular and Interventional Radiology, 37(3), 664–671.
