Abstract Background This systematic review and meta-analysis aimed to comprehensively compare these two therapeutic approaches regarding peri-operative and post-operative outcomes. Method Studies reporting on peri-operative and post-operative outcomes of PAE and TURP in BPH patients were included. Meta-analyses were performed to assess differences in outcomes such as IPSS, post-void residual (PVR), maximum urinary flow rate (Qmax), Prostate volume, procedural time, and Quality of Life (QoL) scores using RevMan 5.4.Methodological assessment was done by using the Newcastle-Ottawa Scale (NOS) for observational studies. Results Our analysis included a total of 9 studies involving 1138 patients. The postoperative subgroup analysis revealed significant differences in IPSS (HR of 1.37 (95% CI: -2.27 to 5.01, p = 0.00001; I2 = 98%), PVR (HR 43.29 (95% CI: -10.38 to 96.96, p = 0.00001; I2 = 99%). In the comprehensive analysis, substantial heterogeneity (98%) was noted, yielding an HR of -9.58 (95% CI: -48.20 to 29.30; p = 0.00001), Prostate volume 13.94 (with a 95% CI: 9.34 to 18.54, resulting in a highly significant p-value of 0.0001 and an I2 statistic indicating 83% heterogeneity), procedural time and QoL, with an HR (54.70) CI: 23-86.39, p<0.00001, I2=96%, and HR (0.27) CI: -0.39-0.93, p<0.00001 and I2=97%, respectively, these all outcomes favoured TURP over PAE. However, post-operative Qmax, (HR -8.48 (95% CI: -13.89 to -3.07, p=0.00001 and an I2 =99%) favoring PAE over TURP. Conversely, PAE exhibited a slower but sustained improvement in QoL scores over time. Complication rates were almost same between the two groups. Conclusions TURP may offer a quicker improvement in BPH; however, PAE also provides a viable alternative with sustained QoL improvements and a potentially lower risk of post-operative complications. Individualized treatment decisions should consider patient preferences and clinical factors.