What Are the Side Effects of Prostate Artery Embolization?

Prostate artery embolization (PAE) is generally well tolerated, with most side effects falling into the mild-to-moderate category and resolving within days to weeks. The most frequently reported cluster of symptoms, collectively called postembolization syndrome, affects roughly one in four patients and includes pelvic pain, burning during urination, and a temporary worsening of urinary symptoms. Serious complications like tissue damage to nearby organs do occur but are rare, and the overall adverse event rate is lower than what is seen after traditional surgical options for enlarged prostates. The specifics, though, matter a great deal depending on what you are most concerned about, whether that is sexual function, radiation, kidney health, or the small but real chance of something going wrong.

Postembolization Syndrome

The side effect you are most likely to experience after PAE is postembolization syndrome, a set of symptoms triggered by the body’s inflammatory response to the newly blocked blood vessels inside the prostate. A systematic review found the overall rate at about 25%, though individual studies report anywhere from roughly 12% to 46% depending on how they define and measure it.¹ The syndrome is not a single symptom but a combination of several, and not everyone gets the full set.

The two most common components are dysuria (a burning sensation when you urinate) and localized pelvic or perineal pain, each occurring in roughly one in five patients. A temporary worsening of lower urinary tract symptoms, the very symptoms PAE is meant to fix, happens in about a third of those who develop the syndrome. Fever shows up in a smaller fraction, around 6–7%, and nausea or vomiting is uncommon at under 2%.¹ In one comparative trial, severe perianal pain was the dominant complaint, relieved with standard painkillers over two to three weeks.²

The important thing about postembolization syndrome is that it is self-limiting. It does not indicate that the procedure failed or that something went wrong. Most symptoms peak within the first few days and taper off. If you go into the procedure expecting a few rough days, you will be better prepared than someone who assumes they will walk out feeling immediately improved.

Effects on Sexual Function

For many men considering PAE, the question that looms largest is whether the procedure will affect erections or ejaculation. This is often the very reason they are exploring PAE instead of surgery, so the evidence here deserves a careful look.

Erectile Function

The consistent finding across multiple studies is that PAE does not harm erectile function on a group level, and may modestly improve it. A study of 167 patients found that erectile function scores ticked upward at 3 and 12 months after the procedure. About 38% of patients who came in with mild-to-moderate erectile difficulties reported improvement at 3 months, while 21% of those with no erectile problems at baseline reported some degree of decline.³ Most changes were small in either direction, with over 80% of patients showing minimal movement in their scores. A large single-center study of over a thousand patients tracked erectile function for up to five years and found no significant decline compared to baseline at any point, with a mild positive trend in the first year.⁴

Why might erections actually improve? It is likely an indirect effect. When severe urinary symptoms disrupt sleep, cause anxiety, and generally reduce quality of life, sexual function suffers alongside everything else. Fix the urinary problems and sexual confidence can rebound. The procedure itself does not target the nerves or blood vessels responsible for erections the way some prostate surgeries can.

Ejaculatory Function

Ejaculation is where the picture gets a bit more nuanced. PAE can cause changes to ejaculation, but the rate is far lower than with traditional prostate surgery. One retrospective study of 39 patients found that about 10% developed some degree of ejaculatory dysfunction after PAE, with one of those four patients reporting improvement over time.⁵ When the group was analyzed as a whole, there was no statistically significant change in ejaculation frequency, strength, or volume.

A larger prospective cohort followed 147 patients for 12 months and found that about 88% retained normal antegrade ejaculation, with a slight improvement in sexual function scores at 18 months.⁶ Still, a head-to-head comparison between PAE and transurethral resection of the prostate (TURP) found that diminished ejaculation was the more common complaint after PAE at about 40%, whereas TURP predominantly caused complete loss of ejaculation in over half of patients.⁷ Histological examination in that study showed that PAE does cause changes to the prostatic glands, seminal vesicles, and ejaculatory ducts, which explains why some degree of ejaculatory change is biologically plausible even if it does not always translate into a subjective complaint.

The takeaway: PAE is substantially friendlier to ejaculatory function than TURP, but “preservation” does not mean zero risk. If maintaining ejaculation is a top priority, PAE is a strong option, though about one in ten men may notice some change.

Non-Target Embolization

The prostate’s arterial blood supply runs through a tangle of small vessels that also feed the bladder, rectum, penis, and surrounding pelvic structures. During PAE, tiny particles are injected to block blood flow to the prostate. If those particles drift into or reflux back into the wrong vessel, they can cut off blood flow to tissues that should have been left alone. This is called non-target embolization, and it is the most discussed serious risk of the procedure.

Structures that can be affected include the bladder, rectum, penis, seminal vesicles, and even pelvic bones or skin.⁸ The consequences depend on which tissue loses its blood supply. A case report documented transient ischemic rectitis, where the patient noticed blood in the stool starting on day one after PAE; colonoscopy confirmed rectal ulcers on day four, but these healed on their own by day 16 without any treatment.⁹ In another reported case, microsphere reflux into an unprotected artery caused a penile ulcer.¹⁰

One of the rarest but most severe outcomes is ischemic necrosis of the glans penis, a condition where the tip of the penis loses blood supply. Case reports exist, but the literature consistently characterizes this as rare.¹¹ Similarly, prostate necrosis itself has been reported. In one case, extensive prostate necrosis developed a month after PAE and was associated with scrotal skin necrosis; the patient required surgical debridement but ultimately improved with intensive treatment.¹²

Interventional radiologists use several techniques to reduce this risk, including “protective embolization,” where nearby non-target arteries are deliberately blocked with coils before the main embolization begins. One study performed protective embolization on 45 arteries, most commonly on the middle rectal artery and the accessory internal pudendal artery. None of the protected branches developed complications.¹⁰ The skill and experience of the operator matter enormously here. Pelvic arterial anatomy varies widely between individuals, and atherosclerosis in older men makes catheter navigation harder.¹³

Vascular Access Site Complications

PAE requires threading a catheter through an artery to reach the prostate’s blood supply, and the entry point can be either the femoral artery (in the groin) or the radial artery (in the wrist). Which access point your interventional radiologist uses can affect your risk of local complications.

A study comparing the two approaches found that bruising at the access site occurred in about 5.5% of groin-access patients versus 0.7% of wrist-access patients, and hematomas followed a similar pattern at about 3.6% versus 0.6%.¹⁴ Two patients who had the wrist-access approach experienced transient ischemic attacks afterward but recovered fully without intervention, and two cases of occult radial artery occlusion were noted, though no patient developed hand ischemia. The trend in the field has been moving toward wrist access where feasible, in part because patients can sit up and walk sooner afterward, and the access site complications are lower.

Radiation Exposure

PAE is performed under fluoroscopic guidance, which means you are exposed to ionizing radiation during the procedure. This is a legitimate concern, especially for a procedure that can take an hour or more. A large multicenter study of nearly 1,500 patients found that the median effective radiation dose was about 18 millisieverts (mSv) on fixed interventional units and about 12 mSv on mobile units.¹⁵ For context, this is in the range of a few CT scans of the abdomen. The dose correlated with body mass index and fluoroscopy time, meaning larger patients and more technically challenging cases received more radiation.

Newer imaging techniques, such as cone beam CT with automated vessel detection, can shorten procedure times. One study found that using this technology reduced median fluoroscopy time from 42 minutes to 28 minutes and cut total procedure time from nearly two hours to just over one hour, though the overall radiation dose distribution shifted between imaging modalities rather than dropping dramatically.¹⁶ No radiation-related adverse events were reported in the 90-day follow-up of the large multicenter study.¹⁵ The theoretical long-term cancer risk from this level of radiation exposure is extremely small, but it is not zero, and it is a factor worth discussing with your doctor if you have had many imaging studies in the past.

Contrast Dye and Kidney Risk

PAE requires iodinated contrast dye to visualize the arteries, and contrast-induced kidney injury is a known risk of any procedure that uses it. For most patients, this is not a significant concern, but it deserves attention if you have pre-existing kidney disease, diabetes, or dehydration. A case report described a 68-year-old man who developed contrast-induced acute kidney injury after PAE that progressed to dialysis-dependent renal failure and cardiac arrest. He was stabilized with intensive care and his kidney function recovered at eight weeks.¹⁷

This is a rare outcome, but it underscores why pre-procedure kidney function testing matters. If your creatinine levels are elevated or your estimated filtration rate is borderline, your medical team should take extra precautions, such as pre-hydration with intravenous fluids and minimizing the volume of contrast used. PAE can involve relatively large volumes of contrast because the operator needs to map out the complex pelvic vasculature, so this is not a trivial consideration for at-risk patients.

Urinary Retention After the Procedure

While PAE is designed to improve urinary flow, a small number of patients temporarily experience the opposite. Some men develop acute urinary retention after the catheter is removed, meaning they are unable to urinate on their own. In one comparative trial, catheter removal after PAE happened on the fifth postoperative day (compared to the third day after TURP), and 10% of the PAE group developed retention requiring further intervention.² This can be alarming, but it typically reflects swelling and inflammation in the prostate tissue as the embolized areas undergo ischemic change. In most cases, a temporary catheter resolves the issue while the swelling subsides.

On the other hand, PAE avoids certain urinary complications that are specific to transurethral surgery. Because the procedure works through the blood vessels and does not physically pass through the urethra, there is no risk of urethral stricture, bladder neck contracture, or the electrolyte disturbance known as TUR syndrome.¹⁸ For men with very large prostates or those on blood thinners who face elevated surgical bleeding risk, this is a meaningful advantage.

How PAE Compares to TURP for Adverse Events

A randomized trial comparing PAE and TURP found that the total number of treatment-related adverse events was about half as high after PAE during the first 12 weeks. The risk of having at least one adverse event was statistically similar between groups (about 63% for PAE versus 71% for TURP), but the likelihood of having two or more adverse events was substantially lower after PAE, at roughly 17% versus 45%.¹⁹ The severity distribution was similar for both, with most events classified as mild. Two-year follow-up data from the same trial confirmed fewer adverse events overall after PAE, though the severity breakdown remained comparable between the two treatments.²⁰

The nature of the side effects differs too. TURP carries higher rates of bleeding requiring transfusion, urethral stricture, incontinence, and retrograde ejaculation. PAE trades those for postembolization syndrome, a small risk of non-target embolization, and radiation exposure. Neither procedure is side-effect-free, but the PAE side-effect profile skews toward discomfort and inconvenience rather than structural damage. That trade-off makes PAE particularly appealing for men who want to avoid general anesthesia, who are concerned about ejaculatory preservation, or who are poor surgical candidates due to age or comorbidities.

The Role of Operator Experience and Embolic Materials

Something that does not get enough attention in patient-facing information about PAE is how much the operator’s skill level affects outcomes. The prostatic arteries are small, tortuous, and anatomically variable. In one large anatomical study, the range of vascular variants was wide enough that the authors emphasized the need for detailed knowledge of pelvic arterial anatomy and a specific skill set to perform the procedure safely.¹³ Non-target embolization, the most serious category of complications, is almost always tied to misidentification of vascular anatomy or unintended reflux of embolic particles, both of which are operator-dependent problems.⁸

The choice of embolic material also matters. Expert consensus suggests that initial PAE should typically use microspheres in the 300 to 500 micrometer range, with different particle sizes reserved for repeat procedures.²¹ Smaller particles penetrate deeper into the prostatic tissue but may carry a higher risk of passing through anastomoses into non-target territories, while larger particles may not achieve adequate embolization. Getting this balance right is part of the procedural art, and centers that perform higher volumes of PAE tend to have better-refined protocols.

If you are considering PAE, asking about your interventional radiologist’s case volume and complication rate is reasonable and encouraged. This is a procedure where experience genuinely translates into safety, more so than with many standardized surgical techniques.

Who Faces Higher Risk

Certain patient characteristics can shift the risk profile of PAE. Atherosclerosis, which is common in the elderly men who make up most of the PAE population, can make catheter navigation through pelvic arteries significantly harder and increase procedure time, radiation dose, and the chance of failing to reach the target artery at all.¹³ Higher body mass index also correlates with increased radiation exposure.¹⁵

Patients with impaired kidney function face the contrast dye concerns discussed earlier. Those with active urinary tract infections should generally have the infection treated before undergoing PAE, since embolizing tissue that is already inflamed or infected raises the risk of abscess formation. Men who are on anticoagulation therapy need careful coordination between their prescribing physician and the interventional radiologist regarding when to hold and restart their medications, though PAE’s lower bleeding risk compared to surgery is actually an advantage for this group.

The best candidates tend to be men with moderate-to-severe lower urinary tract symptoms from an enlarged prostate who want to avoid surgery, who have prostates too large for certain minimally invasive options, or who have medical conditions that make general anesthesia risky. The worst candidates are those with severely diseased pelvic arteries that cannot be safely navigated, significant kidney impairment, or active pelvic infections.

1
PubMed Central. Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review
2
PubMed Central. Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia
3
PubMed. Effect of Prostate Artery Embolization on Erectile Function – A Single Center Experience of 167 Patients
4
Journal of Vascular and Interventional Radiology. Mid- to Long-Term Outcomes of Prostatic Artery Embolization: A Single-Center Retrospective Study of 1,075 Patients
5
PubMed. Ejaculatory dysfunction following prostate artery embolization: A retrospective study utilizing the male sexual health questionnaire-ejaculation dysfunction questionnaire
6
PubMed. Sexual and functional outcomes of prostate artery embolisation: A prospective long-term follow-up, large cohort study
7
PubMed Central. Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials
8
PubMed. A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH
9
PubMed. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature
10
PubMed Central. Protection of nontarget structures in prostatic artery embolization
11
PubMed Central. Case report of avascular necrosis of the glans penis after PAE embolization
12
PubMed Central. Prostatic and scrotal necrosis following prostate artery embolization: a rare complication with a successful long-term outcome
13
Egyptian Journal of Radiology and Nuclear Medicine. Anatomical variants in prostatic artery embolization in treatment of benign prostatic hyperplasia
14
PubMed. Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access
15
PubMed. Multicenter Quantification of Radiation Exposure and Associated Risks for Prostatic Artery Embolization in 1476 Patients
16
Journal of Clinical Interventional Radiology ISVIR. Cone Beam CT with Automatic vessel Detection Software versus Conventional 2D Fluoroscopy with Overlay for Prostate Artery Embolization
17
Ugeskrift for Læger. Contrast-induced acute kidney injury after prostatic artery embolization
18
PubMed Central. Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and meta-analysis
19
BMJ. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial
20
PubMed. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: 2-yr Outcomes of a Randomised, Open-label, Single-centre Trial
21
PubMed Central. Controversies in Prostate Artery Embolization: Future Best Practice