Minimally invasive vs standard surgical treatment: A systematic review comparing prostatic artery embolization and...

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS). While transurethral resection of the prostate (TURP) is widely regarded as the standard surgical treatment, prostatic artery embolization (PAE) has emerged as a minimally invasive alternative. This systematic review compares the effectiveness and safety of PAE and TURP in the management of BPH.

We conducted a systematic review in accordance with PRISMA guidelines, including prospective and retrospective studies that directly or indirectly compared PAE and TURP. Searches were performed in PubMed, Science Direct, and Cochrane Library. Key outcomes assessed included the International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Q_max), post-void residual volume (PVR), prostate volume (PV), the International Index of Erectile Function (IIEF-5), prostate-specific antigen (PSA), and adverse events.

A total of 18 studies, published between 2005 and 2025, were included in the review. Both PAE and TURP demonstrated significant improvements in IPSS and QoL, with comparable outcomes in most studies. TURP, however, consistently resulted in a greater reduction in PVR and PV due to its mechanism of physically removing prostatic tissue. In terms of safety, PAE was associated with minor, transient complications such as post-embolization syndrome, while major complications were infrequent.

Both PAE and TURP are effective treatments for LUTS leading to significant improvements in patient symptoms and quality of life. While TURP provides a greater reduction in prostate volume and residual urine, PAE offers a less invasive option with a favorable safety profile, making it a viable alternative, especially for high-risk surgical candidates.