Medical encyclopedia · Cochin AP-HP
Prostate embolization (PAE) vs TURP vs laser: which option for BPH?
Detailed comparison of minimally invasive and surgical treatments for prostatic hyperplasia: hospital stay, sexual function, risks and functional results
Cochin Hospital AP-HP · Prof. Anthony Dohan · Updated April 2026
| Criterion | Embolization (PAE) | RTUP | HoLEP | GreenLight KTP |
|---|---|---|---|---|
| Anaesthesia | Local + sedation | Spinal or general | General | Spinal or general |
| Hospital stay | 1 nuit | 2-4 jours | 2-4 jours | 1-3 jours |
| Recovery | 3-7 jours | 4-6 weeks | 4-6 weeks | 2-4 weeks |
| Retrograde ejaculation | < 5 % | 60-90 % | 75-90 % | 40-65 % |
| Erectile dysfunction | Nulle | 5-10 % | 5-10 % | 5-10 % |
| Efficacy on IPSS | High (−10 to −14) | Very high (−15 to −20) | Very high | Very high |
| Urethral stricture | Nul | Possible | Faible | Faible |
| Large prostates (> 80 mL) | Adapte | Difficile | Reference | Possible |
Major advantage of PAE: preservation of sexual function
Prostate embolization is the only BPH treatment that almost completely preserves ejaculation (risk of retrograde ejaculation < 5% vs 60-90% for TURP). This is a decisive criterion for young or sexually active patients.
Prostate embolization is the only BPH treatment that almost completely preserves ejaculation (risk of retrograde ejaculation < 5% vs 60-90% for TURP). This is a decisive criterion for young or sexually active patients.
How to choose between PAE and surgery?
PAE preferred if:
- Patient wishing to preserve sexual function (ejaculation)
- Contraindication to general or spinal anaesthesia
- Refusal of surgery
- Long-term anticoagulation
- Very large prostate (> 100 mL), as preparatory or definitive treatment
Surgery preferred if:
- Refractory complete urinary retention
- Associated bladder stones requiring removal
- Obstructive renal failure
- Need for histological confirmation
Frequently asked questions
Is prostate embolization less effective than surgery?
PAE is less effective than TURP (the surgical gold standard) at improving urinary flow rate, but it is superior to medical treatments and preserves sexual function. IPSS improvement is equivalent to TURP in most series at 1 year.
Can PAE be performed after a previous TURP?
Yes, PAE can be offered in case of recurrence after TURP. The residual prostatic vascularisation usually allows effective treatment.
Does PAE preserve fertility?
As ejaculation is preserved, theoretical fertility is maintained. However, the impact of PAE on sperm quality is not fully documented. This question is discussed at the consultation if the patient is planning to have children.
Learn more
Prostate embolization at Cochin AP-HP
Procedure, technique, results and follow-up of prostate embolization.