If an enlarged prostate is making it difficult to urinate, interrupting your sleep, or keeping you close to a bathroom, medication may be the first treatment you try. But medication does not provide enough relief for every patient. Some men also experience side effects or simply do not want to remain on medication indefinitely.
At that point, you may begin comparing procedures such as prostate artery embolization, or PAE, and transurethral resection of the prostate, commonly called TURP.
Both procedures can improve urinary symptoms caused by benign prostatic hyperplasia (BPH), but they work in very different ways. TURP removes obstructing prostate tissue through the urethra. The PAE procedure reduces blood flow to the prostate so the enlarged tissue gradually shrinks.
The right choice depends on more than prostate size. Your symptoms, bladder function, overall health, treatment goals, and feelings about recovery and sexual side effects should all be part of the conversation.
PAE vs. TURP at a Glance
PAE is a minimally invasive, image-guided procedure performed through an artery in the wrist or groin. TURP is a surgical procedure performed through the urethra.
TURP generally produces a larger and more immediate improvement in urinary flow. PAE typically involves less bleeding, a shorter recovery, and a lower risk of ejaculatory dysfunction. However, symptom improvement after PAE develops more gradually, and some patients may eventually need additional treatment.
Comparison | PAE | TURP |
Treatment approach | Reduces blood flow so the prostate gradually shrinks | Surgically removes obstructing prostate tissue |
Anesthesia | Usually local anesthesia with sedation | Usually spinal or general anesthesia |
Setting | Typically outpatient | Hospital or surgical center |
Symptom relief | Gradual, often over several weeks | Usually faster and more pronounced |
Recovery | Often a few days | Commonly several weeks |
Sexual side effects | Lower risk of ejaculatory problems | Retrograde ejaculation is common |
Future treatment | Retreatment is more likely | Retreatment is generally less likely |
Current evidence shows that both procedures can provide meaningful relief of BPH symptoms. TURP generally produces greater improvements in urinary flow and bladder emptying, while PAE is associated with less bleeding, shorter catheterization, and a shorter hospital stay. Retreatment is more common after PAE, which should be considered when weighing long-term trade-offs.
What Is Benign Prostatic Hyperplasia?
Benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. The prostate sits below the bladder and surrounds part of the urethra, the tube that carries urine out of the body.
As the prostate grows, it can narrow the urethra and interfere with bladder emptying. Common symptoms include:
- A weak or interrupted urine stream
- Difficulty starting urination
- Straining to urinate
- A frequent or urgent need to urinate
- Waking several times at night to use the bathroom
- Dribbling after urination
- Feeling that the bladder has not emptied completely
BPH is not prostate cancer, but the two conditions can cause some of the same symptoms. Urinary problems can also result from infection, bladder dysfunction, urethral narrowing, medication, or other conditions. A proper evaluation is important before choosing any treatment.
What Is the PAE Procedure?
Prostate artery embolization is a minimally invasive treatment for BPH performed by an interventional radiologist. Interventional radiologists use medical imaging to navigate very small catheters through the blood vessels and treat a condition from inside the body.
During the PAE procedure, the physician makes a tiny puncture in an artery near the wrist or groin. A small catheter is guided into the arteries supplying the prostate. Microscopic particles are then delivered into those vessels, reducing blood flow to the enlarged tissue.
Over the following weeks and months, the treated prostate tissue shrinks. As pressure around the urethra decreases, urinary symptoms may improve.
PAE does not involve cutting away prostate tissue, inserting surgical instruments through the urethra, or making a traditional surgical incision. It is usually performed using local anesthesia and light sedation, and most patients return home the same day.
The American Urological Association states that PAE may be offered as a treatment for lower urinary tract symptoms caused by BPH when the procedure is performed by a properly trained clinician. The Society of Interventional Radiology’s 2026 guidance also recognizes PAE as an effective alternative to conventional surgical treatment for appropriately evaluated patients.
What Is TURP?
Transurethral resection of the prostate, otherwise known as TURP, has been used for decades and remains a well-established surgical treatment for BPH.
During TURP, a urologist passes an instrument called a resectoscope through the penis and into the urethra. An electrical loop is used to remove pieces of prostate tissue that are obstructing urine flow.
There is no external incision, but TURP is still surgery. It is usually performed under spinal or general anesthesia. Patients typically need a urinary catheter afterward, and some remain in the hospital overnight or longer depending on their health and recovery.
Because TURP directly removes obstructing tissue, it often produces a faster and more substantial improvement in urine flow than PAE. It may be particularly appropriate when strong relief of a confirmed obstruction is the primary treatment goal.
Which Procedure Has an Easier Recovery?
PAE usually has a shorter, less disruptive recovery.
After PAE, patients may experience pelvic pressure, urinary frequency, burning with urination, fatigue, or mild nausea. These temporary symptoms are sometimes described as post-embolization syndrome. Most patients can walk shortly after the procedure and return home the same day.
Light activity is often possible within a few days. Strenuous exercise and heavy lifting may need to wait a little longer based on the physician’s instructions.
Recovery after TURP commonly takes longer because the urethra and prostate need time to heal. A catheter may remain in place for a few days. Blood in the urine, urinary urgency, bladder spasms, and discomfort with urination can occur during early recovery.
Patients are commonly asked to avoid heavy lifting, strenuous exercise, and sexual activity for several weeks after TURP. Individual instructions vary, so follow the recommendations provided by the treating urologist.
How Do PAE and TURP Affect Sexual Function?
Sexual side effects are an important part of the PAE versus TURP decision.
TURP frequently causes retrograde ejaculation. This means semen travels backward into the bladder rather than exiting through the penis during orgasm. Retrograde ejaculation is not usually dangerous, but it can change the experience of orgasm and affect fertility.
TURP can also cause erectile dysfunction, although this is less common than ejaculatory changes.
PAE does not remove tissue from around the urethra and is less likely to interfere with ejaculation. Most patients maintain erectile and ejaculatory function, but no procedure is risk-free. Changes in sexual function can still occur and should be discussed before treatment.
For a patient who places a high priority on preserving ejaculation, the lower risk associated with PAE may carry significant weight. For another patient, achieving the greatest possible improvement in urinary flow may matter more. Both priorities are valid.
What Are the Risks of PAE?
PAE has a favorable safety profile when performed by an experienced interventional radiologist, but it still carries potential risks. These can include:
- Bruising or bleeding at the arterial access site
- Temporary pelvic discomfort
- Burning, frequency, or urgency with urination
- Urinary tract infection
- Temporary urinary retention
- Reaction to iodinated contrast
- Injury to a blood vessel
- Unintended delivery of particles to nearby tissue
- Incomplete symptom improvement
- Need for another BPH treatment
PAE also uses fluoroscopy, a form of real-time X-ray imaging. Experienced physicians use careful technique to limit radiation exposure and protect surrounding structures.
Because PAE does not remove prostate tissue, it does not provide a tissue sample for pathology. Patients should be evaluated for possible prostate cancer and other causes of urinary symptoms before undergoing treatment.
What Are the Risks of TURP?
Possible risks of TURP include:
- Bleeding
- Infection
- Temporary difficulty urinating
- Urinary urgency or incontinence
- Urethral or bladder-neck scarring
- Retrograde ejaculation
- Erectile dysfunction
- Need for blood transfusion
- Fluid or electrolyte complications
- Need for future treatment if prostate tissue grows or symptoms return
Modern bipolar TURP techniques have reduced some of the fluid-related risks associated with older monopolar methods. Even so, a patient’s medications, heart and lung health, bleeding risk, and ability to undergo anesthesia should be considered before surgery.
PAE vs. TURP: How Do You Decide?
There is no single treatment for BPH that is right for every man.
TURP generally offers greater and faster relief of urinary obstruction. It is a well-established option with extensive long-term evidence. Its tradeoffs include anesthesia, a longer recovery, more bleeding risk, and a high likelihood of retrograde ejaculation.
PAE offers a less invasive path. It usually allows patients to return home the same day, involves less bleeding, and is less likely to affect ejaculation. Its results develop more gradually, and the chance of needing another treatment is higher than after TURP.
Consider asking your physician:
- Are my symptoms definitely caused by an enlarged prostate?
- How large is my prostate, and does its shape affect my options?
- Is my bladder still functioning well?
- How much symptom and flow improvement can I reasonably expect?
- How important is preserving ejaculation?
- What anesthesia will I need?
- How long will I need a catheter?
- How much time should I plan to take away from work or exercise?
- What is the likelihood that I will need another procedure?
- Should I meet with both a urologist and an interventional radiologist?
A careful consultation should give you realistic expectations for both treatments, including the benefits and limitations.
Explore Prostate Artery Embolization in Denver and Pueblo
If BPH medication is not providing enough relief, surgery is not your only option.
ECCO Medical provides prostate artery embolization consultations for patients in the Denver area at its Lone Tree location and in Pueblo, Colorado. Our interventional radiology team evaluates each patient individually to determine whether the PAE procedure may be an appropriate treatment for BPH.
A consultation does not commit you to a procedure. It gives you an opportunity to review your symptoms, medical history, prior testing, prostate anatomy, and personal goals with a specialist.
Book an appointment with ECCO Medical to learn whether prostate artery embolization could help you achieve meaningful BPH relief without traditional prostate surgery.
Frequently Asked Questions About PAE vs. TURP
Is PAE better than TURP?
Neither treatment is better for every patient. TURP generally provides greater improvement in urine flow and bladder emptying. PAE offers a shorter recovery, less bleeding, and a lower risk of ejaculatory dysfunction. Your diagnosis and treatment priorities determine which option may be better for you.
Is prostate artery embolization considered surgery?
PAE is a minimally invasive, catheter-based procedure rather than traditional prostate surgery. It is performed through a small arterial puncture and does not require a surgical incision or removal of prostate tissue.
How quickly does PAE improve BPH symptoms?
Some patients notice improvement within the first few weeks, but prostate shrinkage and symptom relief often continue over several months. PAE does not usually produce the immediate change in urine flow that can occur after TURP.
Can TURP be performed after PAE?
Yes. Having PAE generally does not prevent a patient from undergoing TURP or another BPH procedure later if additional treatment becomes necessary.
What type of doctor performs PAE?
PAE is performed by an interventional radiologist who has specific training and experience in catheter-based arterial procedures. TURP is performed by a urologist.
Where can I receive PAE in Colorado?
ECCO Medical evaluates patients for prostate artery embolization at its Lone Tree location, serving the Denver metro area, and its Pueblo location. Eligibility is determined through an individualized consultation and review of appropriate diagnostic testing.
