Prostatic artery embolisation (PAE) is a minimally invasive radiology procedure for urinary symptoms caused by benign prostate enlargement. A trained interventional radiologist passes a fine catheter through an artery, identifies the arteries supplying the prostate and injects tiny particles to reduce its blood supply. The prostate gradually shrinks and symptoms can improve without a transurethral resection. PAE usually causes less bleeding, shorter catheterisation and a quick recovery, but symptom and flow improvement are generally less pronounced and retreatment is more common than after TURP. Patient selection should be shared between a urologist and an experienced interventional radiologist.

What is Prostatic Artery Embolisation (PAE)?

PAE causes controlled reduction of prostate blood flow. Over the following weeks and months, the treated gland undergoes ischaemic shrinkage and the pressure on the urethra decreases.

Because pelvic arterial anatomy is variable, the procedure requires detailed angiographic identification of the prostatic arteries while protecting branches that supply the bladder, rectum or penis.

Who may be suitable?

The procedure should be chosen after confirming that the symptoms are genuinely related to benign prostate obstruction rather than infection, urethral narrowing, bladder disease or a weak bladder alone.

• Moderate-to-severe BPH symptoms in a patient who wishes to consider a minimally invasive alternative.
• Patients who want to avoid transurethral surgery and accept that urinary improvement may be less powerful.
• Selected men with larger prostates where embolisation anatomy is favourable.
• Patients in whom anaesthetic or bleeding considerations make a catheter-based radiology approach attractive after multidisciplinary review.
• Men who understand the possibility of later retreatment.

When may another treatment be better?

• Severe obstruction with complications where the most reliable and rapid de-obstruction is needed.
• Advanced bladder weakness when the outlet is not the main reason for poor emptying.
• Unfavourable, severely atherosclerotic or technically inaccessible pelvic arterial anatomy.
• A patient seeking the maximum possible increase in flow or the lowest retreatment risk.
• Suspicion of prostate or bladder cancer that needs urological investigation before treating presumed BPH.

How is the procedure done?

PAE is usually performed through an arterial puncture in the wrist or groin. Under X-ray guidance, a microcatheter is advanced into each prostatic artery. Contrast imaging confirms the target vessels and checks for branches to nearby organs. Embolic particles are then injected until the intended blood flow reduction is achieved.

No instrument is normally passed through the urethra unless urinary drainage is separately required.

Anaesthesia and hospital stay

PAE is commonly performed with local anaesthesia at the arterial puncture site plus light sedation. It is often a day procedure or requires only a short stay.

Will I need a catheter?

Many men do not need a new urinary catheter solely because of PAE. Men who already have a catheter for retention may keep it until prostate swelling and obstruction have improved enough for a trial without catheter.

Potential benefits

• No transurethral tissue resection.
• Usually little blood loss.
• Local anaesthesia is often sufficient.
• Short hospital stay and quick return to routine activity.
• Erections and ejaculation are usually preserved.

Important limitations

• Improvement in urinary flow and objective obstruction is generally less than with TURP.
• Benefit develops gradually rather than immediately.
• Retreatment rates are higher than after TURP in guideline reviews.
• Requires highly trained interventional radiology expertise and careful pelvic angiography.
• Rare non-target embolisation can injure nearby pelvic organs.

Where PAE sits in current guidelines

The 2026 EAU guideline gives PAE a weak recommendation for men with moderate-to-severe symptoms who want a minimally invasive option and accept less-optimal outcomes than TURP. It also states that PAE remains under investigation and strongly recommends that selection, work-up and follow-up be shared between urologists and trained interventional radiologists.

In practical terms, PAE is most compelling when avoiding a transurethral operation or a larger anaesthetic burden solves a real patient problem. It is less convincing when the main goal is the strongest possible increase in flow, rapid relief of severe obstruction or the lowest retreatment risk.

Recovery after treatment

Pelvic aching, urinary frequency, burning, fatigue, nausea or a low-grade inflammatory feeling can occur for a few days as part of post-embolisation symptoms. The arterial puncture site may be bruised or tender.

Urinary improvement usually develops over weeks rather than immediately. Activity restrictions also depend on whether access was through the wrist or groin.

Erections and ejaculation

PAE usually has a low rate of new erectile or ejaculatory dysfunction, which is one of its attractions. However, rare non-target embolisation can affect penile or other pelvic blood supply, so meticulous technique is essential.

Risks and side effects

• Post-embolisation pelvic discomfort, urinary frequency or burning.
• Blood in the urine or semen.
• Urinary infection or temporary retention.
• Bruising or bleeding at the artery puncture site.
• Arterial spasm, thrombosis or contrast-related complications.
• Rare non-target embolisation affecting bladder, rectum, penis or other tissues.
• Incomplete symptom relief or need for later BPH surgery.

What to bring for consultation

• Ultrasound report showing prostate volume and post-void residual urine.
• Uroflowmetry result if available.
• Urine routine/culture and serum creatinine.
• PSA report when it has been advised as part of your prostate assessment.
• A list of prostate medicines, blood thinners and other regular medicines.
• Records of previous retention, catheterisation or prostate/urethral procedures.

FAQs

Related reading

• Which Prostate Surgery Is Best for Me? TURP, HoLEP or Other Options
• Can Enlarged Prostate Be Treated Without Surgery?
• Post-Void Residual Urine: How Much Urine Left in the Bladder Is Normal?
• Minimally Invasive Treatments for Enlarged Prostate
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male LUTS: Disease Management, 2026 https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/disease-management
• American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia Guideline https://www.auanet.org/guidelines-and-quality/guidelines/bph-guideline
• National Institute for Health and Care Excellence. Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia https://www.nice.org.uk/guidance/ipg611