Treatment Delays Increase the Risk for Complications in Patients with Benign Prostatic Hyperplasia

Delaying medical treatment for benign prostatic hyperplasia (BPH) for more than 1 year after diagnosis significantly raises the risk of both short- and long-term complications, according to real-world clinical data presented at the 2026 Annual Meeting of the American Urological Association in Washington, D.C. 

Timely interventions after a diagnosis of BPH are vital for preserving bladder function and avoiding severe complications. Although the contemporary algorithm for the management of BPH relies on a wide range of medications and minimally invasive therapies, guideline recommendations may not always translate into timely or adequate treatment in clinical practice. 

Researchers in the urology department at Brigham and Women’s Hospital in Boston used data from nearly 44,000 patients with BPH included in the American Urological Association Quality (AQUA) Registry to analyze the impact of treatment delays on symptom progression and complications. The AQUA Registry contains contemporary information on more than 1.5 million patients with BPH, extracted from the electronic health records of over 200 active urological practices across the United States. Patients selected for the analysis were aged 40 years or older (with a median age of 67 years), had no prior BPH or prostate cancer treatments, and reported moderate-to-severe lower urinary tract symptoms (LUTS). Nearly half (45%) of the included patients received at least one therapy for BPH. Those electing medical treatment had a higher prevalence of comorbidities, such as diabetes mellitus and hypertension, while individuals who underwent surgical therapy had more severe urinary symptoms. Minimally invasive surgical therapies, which were performed in 20% of the cohort, included transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), laser enucleation, Aquablation, prostatic urethral lift (PUL), and water vapor thermal therapy (WVTT). 

The analysis showed that delaying medical treatment for BPH longer than 12 months after diagnosis was associated with significantly greater odds of disease-related complications reported at the 1-month and the 1-year follow-up visits after treatment. Moreover, disease-related complications tended to occur earlier in patients who delayed any form of BPH treatment beyond 1 year after the BPH diagnosis. Patients undergoing surgical procedures were at a higher risk of experiencing complications such as catheterization, clot evacuation, and fulguration if they delayed treatment for 12 months or longer. 

Complication rates reported 30 days after treatment were higher for Aquablation (29.6%) compared to all surgical treatments (18.2%) and lowest among patients undergoing PUL (12.2%). Patients who underwent TURP, PVP, or PUL within 3 years of their diagnosis had a longer time to subsequent complications than those who pursued treatment after 3 years. Time to complications and retreatment was also longer for patients who pursued medical therapy within 3 years of a BPH diagnosis.

In terms of symptom relief, individuals who underwent minimally invasive surgical procedures had a significant improvement in the severity of LUTS by 3 months after treatment. However, those who delayed surgery for more than 12 months after diagnosis no longer experienced significant early improvements in urinary symptoms. 
The data from the AQUA Registry suggest that early medical and surgical treatment of BPH is key to delaying complications and re-treatment of BPH. The authors cautioned that geographic and racial differences and the limited information regarding symptom severity may limit the generalizability of the findings. 

“Delaying BPH treatment from time of diagnosis is associated with a significantly shorter time to disease-related complications,” the authors concluded. “These findings reflect a real-world clinical experience, although the patients’ perceived benefit in pursuing upfront treatment must also be considered.”