Open Access

ARTICLE

Quality of life and surgical treatment regret in patients with benign prostatic hypertrophy: a multicenter study

Joshua Winograd¹, Rebecca Kindler², Cassidy Lleras², Alia Codelia-Anjum³, Naeem Bhojani⁴, Dean Elterman⁵, Michael A. Diefenbach³, Daniel Ufearo², Katharine Kechejian², Siri Drangsholt², Bilal Chughtai^3,*

1 Department of Urology, Weill Cornell Medicine, New York City, NY 10021, USA
2 Westchester Medical Center, Department of Urology/Urogynecology, New York Medical College School of Medicine, Valhalla, NY 10595, USA
3 Department of Urology, Northwell Health, Syosset, NY 11791, USA
4 Department of Urology, University of Montreal, Montreal, QC H3C 3J7, Canada
5 Division of Urology, University of Toronto, Toronto, ON M5R 0A3, Canada

* Corresponding Author: Bilal Chughtai. Email:

Canadian Journal of Urology 2025, 32(3), 219-227. https://doi.org/10.32604/cju.2025.064404

Received 14 February 2025; Accepted 28 May 2025; Issue published 27 June 2025

Abstract

Introduction: Benign prostatic hypertrophy (BPH) is a common condition affecting men later in life, significantly impacting quality of life (QOL). Surgical intervention is often pursued when medical management fails, but patient satisfaction with outcomes varies. Decisional regret can affect perceived success and patient satisfaction post-surgery. This study evaluates the relationship between post-surgical symptoms and decisional regret across BPH procedures. Methods: A prospective, multicenter cohort study included 54 patients undergoing BPH surgery between March 2023 and February 2024. Patients completed the International Prostate Symptom Score-QOL (IPSS-QOL) scale preoperatively and at least three months postoperatively, along with the Decision Regret Scale (DRS). Surgical types included Urolift, Greenlight Laser, Rezum, Aquablation, and transurethral resection of the prostate (TURP). A DRS score of ≥25 indicated significant regret. Changes in IPSS-QOL were correlated with DRS scores (Spearman’s rho), and subgroup comparisons were conducted using Mann-Whitney U tests. Results: The average DRS score was 18.3, with 33% of patients reporting a DRS ≥25. Moderate correlations existed between quality of life (QOL) change (ρ = 0.34, p < 0.05) and total regret score. Minimally invasive surgical treatment (MISTs) patients demonstrated higher regret correlations than TURP. Lack of efficacy (75%), new symptoms (41%), and postoperative complications (25%) were the most common reasons for regret. Conclusion: While BPH surgery generally improves symptoms, a substantial portion of patients experience decisional regret. This underscores the importance of preoperative counseling to establish realistic expectations and reduce regret. Further research should explore strategies to enhance shared decision-making and align patient expectations with possible surgical outcomes.

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