PAE vs. Traditional BPH Surgery: What Men Should Know Before Choosing Treatment

Medically reviewed by Dr. Theodore Bryan, MD, Interventional Radiology · Last updated September 2026

If medications are no longer controlling the symptoms of an enlarged prostate, the next conversation is often about procedures — and that raises real questions: Will I need surgery? Will I need general anesthesia? How long will recovery take? Could treatment affect sexual function?

The good news is that men with benign prostatic hyperplasia, or BPH, now have several treatment options. One of them is prostatic artery embolization (PAE), a minimally invasive procedure performed through the blood vessels rather than through the urethra. Understanding how PAE differs from traditional BPH procedures can help you have a more informed conversation with your urologist and treatment team.

Why does an enlarged prostate cause urinary problems?

The prostate surrounds part of the urethra, the tube that carries urine out of the bladder. As prostate tissue enlarges, it can place pressure on the urethra and interfere with normal urine flow. Common BPH symptoms include a weak or slow urine stream, difficulty starting urination, frequent urination, urinary urgency, a feeling that the bladder hasn’t emptied completely, dribbling after urination, and waking several times during the night to urinate.

BPH becomes increasingly common as men age and is particularly common after age 50. For some men, lifestyle changes or medications provide adequate relief. Others continue experiencing bothersome symptoms despite medication, or prefer to explore procedural treatment sooner.

What is traditional BPH surgery?

Several surgical and minimally invasive procedures can be used to treat BPH. Many traditional approaches reach the prostate through the urethra and remove, vaporize, cut, or reposition prostate tissue to create a wider passage for urine. The specific procedure recommended depends on factors including prostate size and anatomy, symptom severity, medical history, and the patient’s treatment goals. Traditional procedures can provide significant improvement for appropriately selected patients, but every procedure has its own recovery expectations and potential side effects.

What is prostatic artery embolization?

PAE approaches the prostate differently. Instead of inserting surgical instruments through the urethra, an interventional radiologist inserts a small catheter into an artery, typically through the wrist or groin. Using advanced imaging, the physician guides the catheter into the arteries supplying the prostate and delivers microscopic particles that reduce blood flow to enlarged prostate tissue.

As the treated prostate tissue receives less blood supply, it gradually shrinks. This can reduce pressure on the urethra and improve urinary symptoms over the following weeks and months. At OC BPH Center, PAE is performed as a minimally invasive, image-guided treatment and typically does not require an incision or general anesthesia.

How is PAE different from traditional prostate procedures?

One of the biggest differences is how the prostate is treated. Traditional procedures generally work directly on prostate tissue through the urinary tract. PAE works through the prostate’s blood vessels. Because PAE does not require surgical access through the urethra, it may be appealing to some men who are looking for a less invasive alternative to traditional surgery.

Potential advantages patients may want to discuss include:

• Minimally invasive treatment
• No surgical incision
• Typically performed without general anesthesia
• Usually performed as an outpatient procedure
• Treatment does not require surgical instruments to pass through the prostate via the urethra
• Potentially shorter recovery compared with some traditional surgical procedures

However, PAE is not necessarily the right treatment for every patient. Evaluation is important because urinary symptoms can have several causes, and prostate size alone does not always predict how severe a man’s urinary symptoms will be.

What about sexual function?

This is an important concern for many men considering BPH treatment. Different BPH procedures have different potential effects on ejaculation, erections, urinary function, and recovery. That’s why treatment selection should involve more than simply asking which procedure makes the prostate smaller — patients should directly ask their care team: “How could this treatment affect my ejaculation and sexual function?” That conversation is especially important for sexually active men who want symptom relief while also considering quality-of-life priorities.

Who might consider PAE?

PAE may be worth discussing if you:

• Have moderate to severe urinary symptoms from BPH
• Wake repeatedly at night to urinate
• Have difficulty starting or maintaining your urine stream
• Feel that medication is no longer providing enough relief
• Experience medication side effects
• Want to explore an alternative to traditional prostate surgery
• Have been told you have a significantly enlarged prostate

Some patients with larger prostates may also be evaluated for PAE, but candidacy depends on more than prostate size alone. A proper evaluation helps determine whether symptoms are truly being caused by prostate enlargement and whether PAE is technically appropriate.

What testing is needed before PAE?

The evaluation may include a review of your symptoms, medical history, current medications, prostate imaging, and previous urologic testing. Your physician may also consider tests such as PSA testing, urinalysis, measurement of post-void residual urine, urinary flow testing, prostate imaging, and other testing when clinically appropriate. These tests help rule out other causes of urinary symptoms and allow your treatment team to understand the anatomy of your prostate and urinary tract.

Don’t ignore worsening urinary symptoms

BPH itself is benign, meaning it is not prostate cancer. However, urinary symptoms should still be evaluated.

Which BPH treatment is right for you?

There isn’t one BPH procedure that’s appropriate for every man. Your ideal treatment depends on your symptoms, prostate anatomy and size, overall health, previous treatments, medications, lifestyle, and priorities regarding recovery and sexual function. For men who want to avoid or postpone traditional prostate surgery, prostatic artery embolization may be an option worth exploring.

This article is for general educational purposes and isn’t a substitute for medical advice. Candidacy for any BPH treatment, including PAE, is determined through an in-person evaluation.