Treatment Regret in Patients Undergoing Minimally Invasive Treatments for Benign Prostatic Hyperplasia

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from consecutive patients undergoing MISTs across five Italian primary care urology centers. All patients underwent a comprehensive clinical assessment, including detailed medical history and physical examination. Preoperative, perioperative, and postoperative variables were recorded. Decision regret was assessed using validated questionnaires, with significant regret defined as a score >25%. Results: A total of 155 patients were included, with a median age of 64 years (IQR 58-66) and a median IPSS of 23 (IQR 18-26). Among them, 90 patients (51%) underwent Aquablation, 21 (12%) received a temporary implantable nitinol device (iTIND), 26 (15%) underwent water vapor thermal therapy (WVTT), and 37 (21%) were treated with prostatic urethral lift (PUL). The overall median decision regret score was 0 (IQR 0-15), with 23 patients (15%) reporting significant regret (>25%). Higher regret rates were observed in patients treated with PUL and WVTT compared to those undergoing iTIND and Aquablation. None of the evaluated variables-including age, BMI, prostate volume, preoperative Qmax, or preoperative IPSS-were significantly associated with treatment regret. However, although not reaching statistical significance, a prostate volume >60 cc was associated with higher regret in patients undergoing WVTT (OR = 3.33) and PUL (OR = 4.2). Conclusions: Among patients undergoing MISTs, treatment regret is not negligible and appears higher when patient selection is suboptimal. Larger studies are warranted to better identify predictors of decision regret and optimize patient selection for these procedures.