Abstract

Benign prostatic hyperplasia is a major cause of lower urinary tract symptoms (LUTS) in aging men. While transurethral resection of the prostate (TURP) remains the standard surgical treatment, prostatic artery embolization (PAE) has emerged as a less invasive alternative. Their comparative effectiveness, safety, and cost remain uncertain. This review aimed to compare PAE and TURP in terms of clinical outcomes, functional results, quality of life, and cost, and to assess hybrid PAE + TURP in men with markedly enlarged prostates. MEDLINE/ PubMed, Cochrane CENTRAL, Web of Science, ProQuest, ClinicalTrials.gov, Scopus, and grey literature were searched from inception to September 21, 2025, for English-language studies directly comparing PAE and TURP. The primary outcomes were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and postvoid residual urine volume (PVR). Secondary outcomes included prostate volume reduction, International Index of Erectile Function (IIEF), quality of life (QoL), retreatment, perioperative complications, and hospital costs. Nineteen studies involving 14,843 patients met the inclusion criteria, and 16 studies with 14,582 patients were included in the meta-analysis. TURP showed greater long-term improvement in IPSS, Qmax, and PVR. No significant overall difference was found in prostate volume reduction. PAE was associated with better preservation of sexual function and quality of life, but retreatment rates were higher. Limited cost data suggested lower in-hospital costs with PAE. Hybrid PAE + TURP showed perioperative and functional advantages in prostates >100 ml. TURP provides more durable urinary improvement, whereas PAE might better preserve sexual function and quality of life.

Key words: Prostatic artery embolization, transurethral resection of the prostate, benign prostatic hyperplasia, functional outcomes, follow-up, systematic review