Objective To investigate whether prostatic arterial embolization (PAE) could be recommended as a routine therapy for benign prostatic hyperplasia (BPH), we conducted an updated meta-analysis to assess the efficacy and safety of PAE compared with transurethral resection of the prostate (TURP). Methods Systematic literature retrieval by searching data from Web of science, Pubmed, Embase, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP databases was carried out to identify all related trials from the inception dates to June 2019. We also conducted subgroup analyses depending on the kind of study design, kind of PAE and kind of TURP. Results Nine studies comparing PAE with TURP involving a total of 860 BPH patients were selected. Postoperative reduced IPSS score (MD 2.50; 95% CI 0.78-4.21;P = 0.004), postoperative reduced QOL score (MD 0.40; 95% CI 0.09-0.71;P = 0.01), postoperative reduced PV (MD 8.59; 95% CI 4.74-12.44;P < 0.00001) and postoperative increasedQ(max)(MD 2.54; 95% CI 1.02-4.05;P = 0.001) were better in TURP than in PAE; however, PAE was associated with lower sexual dysfunction rate (OR 0.24; 95% CI 0.15-0.39;P < 0.00001) compared with TURP. Meanwhile, no significant difference in postoperative reduced PVR (MD 0.46; 95% CI - 2.08 to 3.00;P = 0.72) and complication (OR 0.57; 95% CI 0.21-1.55;P = 0.27) between PAE and TURP group was demonstrated. Conclusion PAE was inferior to TURP in the improvement of postoperative IPSS, QOL, PV,Q(max)and TURP still remained the gold standard. However, PAE may be a valuable alternative to TURP in the treatment of BPH patients who refuse surgery or with surgery contraindication.