What drives men to BPH surgery? A multidomain analysis of patient-reported outcomes before BPH intervention

Background: While the literature on benign prostatic hyperplasia (BPH) often focuses on postoperative patient-reported outcomes (PROs), less attention has been paid to preoperative PRO findings that may influence a patient’s decision to pursue surgery. This study provides a descriptive analysis of preoperative PROs in patients undergoing surgical intervention for BPH. Materials and methods: This retrospective analysis of a single-institution BPH database from 2021 to 2024 assessed preoperative International Prostate Symptom Score (IPSS), Michigan Incontinence Symptom Index (MISI), and Sexual Health Inventory for Men (SHIM) score. Descriptive statistics and Mann–Whitney tests were applied to total and subgroup PRO scores. Results: A total of 1874 patients underwent BPH surgery (average age 71.1). The mean IPSS score was 16.60 (of 35), with a quality-of-life score of 3.89 (of 6). Voiding symptoms were significantly different from storage symptoms (9.07 of 20 vs. 7.69 of 15, p < 0.0001). The distribution of IPSS severity was 15.6% mild (1–7), 44.2% moderate (8–19), and 40.2% severe (20–35). The mean MISI score was 5.81 (of 32), with 34.9% of patients meeting criteria for preoperative incontinence (total score ≥ 7). Preoperative urge urinary incontinence scores were higher than stress urinary incontinence scores (3.55 vs. 1.48, p < 0.0001). The mean SHIM score was 15.05 (of 25), with 27% severe, 10% moderate, 14% mild-to-moderate, 24% mild, and 25% no erectile dysfunction. Preoperative PROs differed significantly across surgical groups, with notable variations in IPSS, MISI, and SHIM domain scores relative to transurethral resection of the prostate. Conclusions: Preoperative BPH patients reported moderately lower urinary tract symptoms, worse storage than voiding symptoms, more urge urinary incontinence than stress urinary incontinence, and mild-to-moderate erectile dysfunction. Understanding baseline PROs enables clinicians to better contextualize postoperative outcomes and manage patient expectations, thereby supporting both optimal care and medicolegal protection in the event of postoperative dissatisfaction.