Prostate Artery Embolization vs. Holmium Laser Enucleation of the Prostate: A Matched Pair Analysis of Functional Outcomes and Complications.

Background: This retrospective matched-pair analysis compared functional outcomes and complications of prostate artery embolization (PAE) using 250 µm microparticles and holmium laser enucleation of the prostate (HoLEP) in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: A total of 69 PAE patients were matched 1:1 to 69 HoLEP patients using propensity scores based on age, prostate volume (PV), and IPSS. Follow-up was standardized at six months for the PAE cohort, while HoLEP outcomes were assessed cross-sectionally (median 52.9 months). All comparisons were therefore interpreted as cross-sectional analyses rather than time-matched outcomes. Secondary endpoints were complications according to the Clavien-Dindo Classification. Results: At baseline, there were no significant differences between PAE and HoLEP regarding IPSS, QoL, or Qmax. Both interventions led to significant within-group improvements in IPSS, QoL, and Qmax (p < 0.001). Between-group comparisons demonstrated significantly greater improvement in IPSS, Qmax, and QoL following HoLEP (all p < 0.05). Erectile function remained stable after PAE and showed a non-significant decrease after HoLEP. Severe complications (Clavien-Dindo ≥ Grade III) were not observed after PAE. These findings should be interpreted considering the study's main limitations, including the small cohort size, its retrospective matched-pair design, and variability in surgeons' HoLEP experience. Conclusions: PAE with 250 µm microparticles and HoLEP are both effective and safe procedures. While PAE compared to HoLEP is less effective regarding functional outcome, it showed no difference in QoL improvement and is associated with no greater grade II complications.