Clinical Trial on the Effectiveness of TUMT Compared to PAE in Reducing Severe LUTS in Men with BPH

Inclusion Criteria: * Ability to understand and the willingness to sign an informed consent. * Diagnosis of LUTS secondary to BPH refractory to/contraindicated for medical treatment or not patient preference. * Severe urinary symptoms on IPSS (IPSS score ≥ 20). * Bladder outlet obstruction (BOO) is defined by Qmax ≤ 15ml/sec, based on uroflowmetry. * Prostate volume at minimum 50 ml measured by TRUS or MR. * Men with prostate cancer in Active Surveillance or Watchful Waiting who have LUTS due to a large BPH component are allowed. * Indwelling catheter or intermittent catheter is allowed. In this case baseline IPSS is 35 points. Exclusion Criteria: * Active bladder cancer (patients with pTa low-grade tumors are allowed). * Previous pelvic radiation for cancer treatment. * Bladder stones (inclusion is allowed after removal). * Current urethral strictures or bladder neck contracture. * Neurogenic LUTS. * Symptomatic urinary tract infection at the time of intervention. * Documented bacterial prostatitis in the last year. * Severe atheromatous disease or other pathology preventing catheter-based intervention (as rated on CT angiography by an interventional radiologist). * Allergy to iodinated contrast media. * Renal failure defined as estimated glomerular filtration rate (eGFR) \< 35ml/min. * High bleeding risk (spontaneous international normalized ratio (INR) \> 1.6). * Contraindication to conscious sedation (if requested by the patient). * Prostate median lobe defined by treating physician. * Urethral colliculus to bladder neck length \<35mm.