Characterization of preoperative patient-reported outcomes in men undergoing benign prostatic hyperplasia surgery

Background: While the literature on benign prostatic hyperplasia (BPH) often focuses on postoperative patient-reported outcomes (PROs), less attention has been paid to preoperative symptom burden and PROs of men who ultimately undergo surgical treatment. This study provides a detailed descriptive analysis of preoperative PROs across the urinary, sexual, and quality of life domains in a large surgical cohort. 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, and Sexual Health Inventory for Men 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). When standardized as a percentage of maximum possible score, storage symptoms were significantly more prominent than voiding symptoms (51.3% vs. 45.4% of maximum, 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 Michigan Incontinence Symptom Index 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 Sexual Health Inventory for Men score was 15.05 (of 25), with 27% severe, 10% moderate, 14% mild-to-moderate, 24% mild, and 25% no erectile dysfunction. Preoperative IPSS storage and total scores were significantly lower in patients who underwent simple prostatectomy, and IPSS quality of life scores were significantly lower in patients who underwent holmium laser enucleation of the prostate, 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.