Patient guide
Prostate symptoms came back after Rezum or UroLift? PAE can still be an option
Had Rezum, UroLift or another minimally invasive prostate procedure, and symptoms returned? In a study of men with large prostates after a failed procedure, symptom scores fell from 23.5 to 11.6 after prostate artery embolization (PAE).
Why men look at PAE after another procedure did not work
- Symptom score about halvedFrom 23.5 to 11.6 on average, in 16 men
- Large prostates treated113 mL on average in that study
- No side effects reportedIn the 16 men studied
- No cuttingTreated from the arteries
When the first procedure does not do enough
Procedures like Rezum (steam) and UroLift (small implants) are popular because they are quick and aim to protect sexual function. They work well for many men, but not for every prostate. Large prostates, in particular, may not respond fully, and symptoms can slowly come back.
Men in that position are often told the only next step is a bigger operation. That is not always the case.
How PAE is different
Rezum and UroLift work from inside the urine pipe. PAE works from outside it, through the blood supply: tiny particles are placed in the small arteries that feed the prostate, and the gland gradually shrinks. Because it does not rely on the urine pipe, it can still be done after other procedures. It is usually done under local anaesthesia, through a tiny puncture, with no cutting.
What a study of these men found
A study looked at 16 men whose symptoms stayed bad after another minimally invasive procedure, and who were then treated with PAE.
| Before PAE | After PAE | |
|---|---|---|
| Prostate size (average) | 113 mL | Large glands were treated |
| Symptom score (IPSS, average) | 23.5 | 11.6 at the last follow-up |
| Quality-of-life score (average) | 4.9 | 2.0 at the last follow-up |
| Side effects | None reported | |
| Erections and ejaculation | Not made worse |
What to know before you decide
This was a small study at one centre, looking back at 16 men, with no comparison group [1]. Results in a larger group of men may be different, and not every man will do as well. A 2026 review of PAE also notes that, compared with surgery through the urine pipe, PAE improves urine flow less and is more often repeated, and that it is best used with careful patient selection [2]. That is why we do not offer PAE to every man. We look at your scans, the procedure you had, and what you want from treatment.
What we check at the consultation
Bring your reports, and ask us anything:
- The report from your earlier procedure, and when it was done
- Your latest prostate ultrasound or MRI, and your PSA
- How your urine symptoms are now, ideally with your symptom score
- Your medicines and your general health
- What matters most to you: sleeping through the night, protecting sex life, avoiding a catheter
Get your symptom score
Our free prostate symptom score takes about two minutes. If your score has crept back into the moderate or severe range, you can send it to our team to talk through the options.
Frequently asked questions
- Can I have PAE after Rezum or UroLift?
- In a small study, 16 men whose symptoms did not settle after another minimally invasive procedure were treated with PAE, and their symptom scores fell from 23.5 to 11.6 on average [1]. Whether it suits you depends on your scans and the earlier procedure.
- Will PAE harm my sexual function after another procedure?
- In that study, PAE did not negatively affect erectile or ejaculatory function [1]. It was a small study, and results differ between men.
- Why would PAE work if the first procedure did not?
- Rezum and UroLift treat the prostate from inside the urine pipe. PAE shrinks the prostate by reducing its blood supply, so it works in a different way.
- Is PAE better than repeating the same procedure?
- We cannot say that from the evidence. Your options depend on your prostate size, your scans and what was done before. We go through them with you at the consultation.
- Where can I discuss this in Hyderabad?
- Dr. Nagateja Bonala offers prostate artery embolization at Clinic Seven. Bring your earlier procedure report, prostate ultrasound or MRI, PSA and medicine list.
Check your prostate symptom score
References
- Goyal P, et al. Prostatic Artery Embolization in Patients with Refractory Lower Urinary Tract Symptoms after a Prior Minimally Invasive Surgical Treatment. J Vasc Interv Radiol. 2024. Read the source
- Tawfellos G, et al. Prostatic Artery Embolization: A Contemporary Review of Efficacy, Safety, and Expanding Clinical Indications. Curr Urol Rep. 2026. Read the source
Want to discuss your options?
Speak with the Clinic Seven team.