What is benign prostatic hyperplasia?
The prostate surrounds the urethra just below the bladder. With age, benign enlargement can narrow the urethral channel and increase resistance to urinary flow. Prostate size and symptom severity do not always correlate perfectly.
Understanding BPH and LUTS
An enlarged prostate can compress the prostatic urethra and contribute to lower urinary tract symptoms (LUTS). Not every urinary symptom is caused by BPH, so evaluation may include history, symptom scoring, urinalysis, prostate-specific antigen when appropriate, post-void residual, uroflow testing, imaging, and urologic assessment.
How PAE works
PAE is performed through a small arterial access site, often at the wrist or groin. Using fluoroscopy and angiography, a microcatheter is advanced into the arteries supplying each side of the prostate. Embolic particles are delivered selectively, leading to ischemic shrinkage of prostatic tissue and gradual improvement in obstruction-related symptoms.
Who may consider PAE?
PAE may be an option for selected men with bothersome LUTS caused by BPH, including some men with very large prostates, bleeding of prostatic origin, urinary retention, or medical conditions that make conventional surgery less attractive. Patient selection is critical because bladder dysfunction, urethral stricture, prostate cancer, infection, and other conditions may mimic or coexist with BPH.
How PAE compares with other BPH treatments
Options for BPH include observation, medications, minimally invasive urologic procedures, transurethral surgery, enucleation procedures, simple prostatectomy, and PAE. Each has different tradeoffs in symptom improvement, durability, anesthesia, bleeding risk, urinary recovery, and sexual side effects. A good decision compares these options rather than treating PAE as universally preferable.
Current professional guidance
SIR released updated practice guidance in June 2026 emphasizing the role of interventional radiology in longitudinal BPH care and describing PAE as an effective minimally invasive alternative to conventional surgical therapies in appropriately selected patients.
Recovery and risks
PAE is usually outpatient. Temporary urinary frequency, urgency, burning, pelvic discomfort, fatigue, or blood in the urine can occur. Potential complications include urinary retention, infection, vascular injury, access-site bleeding, and rare nontarget embolization. Improvement is gradual rather than immediate.
Procedure Video
See prostate artery embolization
PAE explanation from Johns Hopkins Medicine. Third-party educational video; technique and equipment vary.