Surgical Regret Is Often Part of the Benign Prostatic Hyperplasia Journey

In a time when men have multiple surgical options for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), selecting the right treatment plan is only half the battle. Findings presented at the 2026 Annual Meeting of the American Urological Association in Washington, D.C. showed that patients who undergo surgery for BPH often live to regret their decisions, especially when the relief of LUTS is suboptimal or incomplete. 

Researchers at the Loyola Stritch School of Medicine in Maywood, Illinois developed an eight-item BPH-specific Surgical Regret Questionnaire to evaluate treatment-related regret among men who underwent bladder outlet surgery to address LUTS secondary to BPH. Participants were asked questions about regret concerning past procedures regardless of surgery type or location. Data gathered from 238 men showed that more than half of the responders underwent convective water vapor thermal therapy (CWVTT), with the rest of the cohort opting for different procedures, including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), and prostatic urethral lift (PUL). 

The analysis revealed that the resolution of symptoms after surgery had a significant impact on regret, as did the number of comorbidities, reflecting the overall health of the patients. The type of procedure also mattered: PVP and TURP had significantly higher regret scores compared to CWVT. Overall, CWVTT was the treatment modality with the lowest regret scores. When controlling for all other factors, higher regret scores were associated with the number of comorbidities, postoperative improvements in International Prostate Symptom Scores, and undergoing PVP. 

“Our study demonstrated that patients experienced less BPH surgery regret when their urinary symptoms improved more and their side effects were minimized,” said presenting author Timothy Han, MD, a urology resident at Loyola University Medical Center. “CWVTT represented the treatment modality with the lowest regret scores. As the BPH treatment space continues to evolve, it remains important to provide patients with thorough counseling of treatment expectations, discussion of all available guideline-approved options, and their respective side effect profiles.” 

The authors noted that the abundance of treatment choices can lead to anxiety, decision fatigue, and regret – which is primarily driven by unrealistic expectations and the patients’ lack of understanding of potential trade-offs. By understanding the prevalence and nature of regret following surgery for BPH, providers are better equipped to personalize treatment plans and address the unmet needs of patients with residual symptoms.