We hypothesized that prostatic artery embolization (PAE) is a viable, minimally invasive alternative to transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), offering superior preservation of sexual function and reduced hospital stays while maintaining comparable quality of life. Our aim was to systematically evaluate and quantitatively compare the efficacy and safety of PAE versus TURP—focusing on sexual function, urinary symptom relief, procedural outcomes, and overall patient-centered quality of life.

A systematic literature search was performed across PubMed, Europe PMC, Google Scholar, DOAJ, OpenGrey, and ClinicalTrials.gov for studies published between January 2008 and March 2025. Studies eligible for inclusion were randomized controlled trials, controlled trials, observational studies, and cohort studies directly comparing PAE with TURP in men with BPH. Key outcomes included sexual function measured by the International Index of Erectile Function (IIEF-5), urinary symptoms via the International Prostate Symptom Score (IPSS), procedural outcomes (adverse events, re-intervention rates, hospital stay duration), and quality of life assessed using IPSS-QoL. Data extraction was independently conducted by five reviewers, with study quality assessed using the Risk of Bias 2 tool. A random-effects meta-analysis was utilized, and heterogeneity was evaluated using I² and τ² statistics.

Seven studies encompassing 614 participants (341 undergoing PAE, 273 undergoing TURP) were included. PAE demonstrated a statistically significant advantage in preserving sexual function (mean difference [MD] = 1.81; 95% CI: 1.25–2.37; p < 0.001) and yielded a shorter hospital stay (risk ratio for hospital stay >2 days = 0.23; 95% CI: 0.07–0.73; p = 0.013). In contrast, TURP achieved a greater reduction in urinary symptoms (MD = 2.48; 95% CI: 1.07–3.89; p < 0.001) and lower re-intervention rates (risk ratio = 3.12; 95% CI: 1.59–6.12; p < 0.001). No significant difference was observed in quality of life outcomes between the two procedures (MD = 0.29; 95% CI: –0.16–0.73; p = 0.208). Heterogeneity ranged from moderate to high across outcomes.

These findings suggest that while TURP remains superior for rapid and sustained urinary symptom relief, PAE provides considerable benefits in sexual function preservation and reduced hospital utilization. The trade-offs observed underscore the importance of individualized, patient-centered decision-making in BPH management.

PAE represents an attractive, minimally invasive option for selected BPH patients—particularly those prioritizing sexual function and shorter recovery times—although its higher re-intervention rate warrants careful patient selection and long-term evaluation.

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