PAE or Rezūm:
the honest comparison
Both shrink the prostate rather than cutting it out, and both keep you out of the operating room, but they get there by opposite routes: PAE starves the gland of blood so it shrinks on its own, Rezūm destroys targeted tissue with steam and lets the body clear it. Dr. Sawkar performs both, prostate artery embolization in the practice's own outpatient lab and Rezūm in the office, so this comparison has no thumb on the scale.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated September 2026
Side by side
Two routes to a smaller gland. PAE starves the excess tissue from the inside, through the arteries; Rezūm destroys it with brief bursts of steam delivered through the urethra. Neither one cuts, and both preserve sexual function far better than traditional surgery.
| PAE | Rezūm | |
|---|---|---|
| How it works | Microspheres reduce the prostate's blood supply; the gland shrinks over weeks | Nine-second bursts of steam destroy targeted tissue, which the body reabsorbs over weeks |
| Setting | Outpatient lab, home the same day | Office visit |
| Anesthesia | Light sedation | Local anesthetic, usually with an oral sedative |
| Catheter | Usually none | Typically three to seven days |
| Back to routine | A day or two | About a week; burning and urgency can linger two to four weeks |
| Prostate size range | No practical ceiling, 200+ cc treated | About 30 to 80 cc; a median lobe is fine |
| Result timeline | Builds over 4 to 12 weeks | Builds over 4 to 12 weeks, occasionally up to 3 months |
| Ejaculation | Preserved in the large majority | Preserved in the large majority; a small minority report changes |
| Durability | Strong; roughly 1 in 5 seek retreatment over years | About 1 in 20 needed a repeat procedure within five years in the pivotal trial |
| Blood thinners | Usually continued | Usually continued |
General patterns, not a promise. Your measured anatomy, health, and goals decide, which is exactly what the consultation is for.
How men actually choose
Choose Rezūm when the gland is small to medium
You want a single office visit under local anesthetic, a result that held up well over five years in the trial, and you can live with a catheter for several days plus a few weeks of burning and urgency while the treated tissue clears. For a gland of roughly 30 to 80 cc, that is a fair trade, and many men take it.
Choose PAE when the prostate is large or the catheter is a deal-breaker
You want to skip the catheter entirely, you take blood thinners you would rather not interrupt, or the prostate is bigger than Rezūm handles well. PAE has no practical size ceiling, recovery is a day or two, and it also fits men whose anatomy sits outside Rezūm's range for any other reason.
Let the measurement referee
Gland volume, shape, median lobe, bladder health, and your medical history all weigh in. A quick ultrasound turns this page's generalities into your specific answer, and often the volume alone settles it: under about 80 cc both are on the table, above it PAE is the one that applies.
Common questions
Which is more effective, PAE or Rezūm
In the size range where both apply, roughly 30 to 80 cc, symptom relief is similar and both build over weeks. Above 80 cc PAE is the only one of the two that applies. Rezūm has the better retreatment record in its trial; PAE has the lighter recovery and no catheter.
Which has the easier recovery
PAE. Most men are back to routine in a day or two with no catheter. Rezūm means a catheter for several days and a few weeks of burning and urgency while the treated tissue is reabsorbed.
Can I have Rezūm first and PAE later
Yes, in either order. Neither removes tissue or changes the anatomy in a way that blocks the other, so starting with one leaves the other fully available.
Does either affect sexual function
Erections are preserved with both. Ejaculation is preserved in the large majority with both, a major difference from TURP, where roughly 2 in 3 men lose it.
Get the answer for your anatomy
One practice, both procedures, no thumb on the scale. Same-day and next-day appointments, telehealth available, Medicare and most PPO plans accepted. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · UroLift Center of Excellence · 250+ Aquablation procedures, the most in Orange County