Review Article
Background: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in ageing men and substantially affects quality of life. Although transurethral resection of the prostate (TURP) remains the surgical standard, prostatic artery embolization (PAE) has become an effective minimally invasive alternative, particularly for elderly patients, those with significant comorbidities or receiving anticoagulation, and men seeking to preserve sexual function.
Objective: To review contemporary evidence on PAE, focusing on patient selection, procedural technique, clinical outcomes, safety, comparative effectiveness, and its role in current international guidelines. This review uniquely synthesises the 2026 guideline updates with emerging evidence on patient selection biomarkers and procedural refinements, providing a practical framework for multidisciplinary decision-making.
Evidence Acquisition: Evidence Synthesis Conclusion A narrative review was performed using PubMed/MEDLINE, Embase, and the Cochrane Library. International guidelines, randomised controlled trials, systematic reviews, and meta-analyses published between 2020 and 2026 were prioritised, with landmark earlier studies included where appropriate. Current evidence demonstrates that PAE provides durable improvements in LUTS, quality of life, urinary flow, and prostate volume with a favourable safety profile. Compared with surgery, it has lower perioperative morbidity, shorter hospitalisation, and better preservation of ejaculatory function. However, urinary flow improvements are smaller, and retreatment rates remain higher than after TURP or endoscopic enucleation.
Conclusion: PAE is an established minimally invasive option for selected men with BPH-related LUTS, particularly those at increased surgical risk or wishing to preserve sexual function. Further long-term randomised studies are needed to optimise patient selection and confirm long-term durability.
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