Beyond symptom relief: quality of life after surgery for benign prostatic obstruction.

Background: Surgery for benign prostatic obstruction (BPO) usually provides substantial relief of lower urinary tract symptoms (LUTS), yet conventional functional measures capture only part of what matters to patients. This scoping review mapped how surgical and minimally invasive treatments influence quality of life (QoL) within a multidimensional, patient-centred framework.

Methods: A systematic search of PubMed, Scopus, and Google Scholar was performed on July 12, 2026, using predefined keywords. Eligible studies included English-language peer-reviewed articles involving adult patients undergoing surgical treatment for LUTS/BPO secondary to benign prostatic hyperplasia who were evaluated for QoL and patient-reported outcomes. Case reports, reviews, conference abstracts, and non-English publications were excluded. Screening was performed independently by two reviewers, with disagreements resolved by a third.

Results: Disease-specific QoL improved after transurethral resection, endoscopic enucleation, vaporization, Aquablation, and minimally invasive treatments. HoLEP/EEP and GreenLight offered urinary benefit broadly comparable with TURP while differing in selected perioperative outcomes. Aquablation and PUL were more clearly distinguished by ejaculation preservation and recovery, whereas PAE achieved less deobstruction. Persistent storage symptoms or transient incontinence could delay recovery, and long-term evaluation depended on independence from catheter and medication and the need for retreatment.

Conclusions: IPSS-QoL alone cannot adequately describe QoL after BPO surgery. Combining urinary bother with storage function, continence, sexual health, recovery, durability, and satisfaction provides a more meaningful account of treatment success and may support more individualized procedure selection.

1. Ye Z, Zhang H, Pan J, et al. Global burden of benign prostatic hyperplasia in males aged 60-90 years from 1990 to 2019: results from the Global Burden of Disease Study 2019. BMC Urol 2024;24:193. DOI: https://doi.org/10.1186/s12894-024-01582-w

2. Cornu JN, Gacci M, Hashim H, et al. EAU guidelines on non-neurogenic male lower urinary tract symptoms. Arnhem: European Association of Urology; 2026.

3. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2023. J Urol 2024;211:11-9. DOI: https://doi.org/10.1097/JU.0000000000003698

4. Coyne KS, Sexton CC, Thompson CL, et al. The prevalence of lower urinary tract symptoms in the USA, the UK and Sweden: results from the Epidemiology of LUTS study. BJU Int 2009;104:352-60. DOI: https://doi.org/10.1111/j.1464-410X.2009.08427.x

5. Glaser AP, Smith AR, Maglaque D, et al. Enhanced clinical decisions for management of benign prostatic hyperplasia using patient-reported outcomes: protocol for a prospective observational study. BMC Urol 2024;24:110. DOI: https://doi.org/10.1186/s12894-024-01500-0

6. Barry MJ, Fowler FJ Jr, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 1992;148:1549-57. DOI: https://doi.org/10.1016/S0022-5347(17)36966-5

7. Barry MJ, Fowler FJ Jr, O'Leary MP, et al. Measuring disease-specific health status in men with benign prostatic hyperplasia. Med Care 1995;33:AS145-55.

8. Barry MJ, Williford WO, Chang Y, et al. Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the AUA symptom index and BPH Impact Index is perceptible to patients? J Urol 1995;154:1770-4. DOI: https://doi.org/10.1016/S0022-5347(01)66780-6

9. Hines L, Mali K, Campbell T, Jain R, Quarrier SO. Advancing holmium laser enucleation of the prostate outcomes reporting: an assessment of patient-reported outcomes in the literature. Urology 2024;187:147-53. DOI: https://doi.org/10.1016/j.urology.2024.02.045

10. Giulioni C, Cafarelli A, Falsetti F, et al. Perioperative outcomes of ongoing antithrombotic therapy during endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2026 Mar 5. doi:10.1038/s41391-026-01098-4. DOI: https://doi.org/10.1038/s41391-026-01098-4

11. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73. DOI: https://doi.org/10.7326/M18-0850

12. Gilling PJ, Wilson LC, King CJ, et al. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 2012;109:408-11. DOI: https://doi.org/10.1111/j.1464-410X.2011.10359.x

13. Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 2004;172:1012-6. DOI: https://doi.org/10.1097/01.ju.0000136218.11998.9e

14. Wilson LC, Gilling PJ, Williams A, et al. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 2006;50:569-73. DOI: https://doi.org/10.1016/j.eururo.2006.04.002

15. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up of a randomised clinical trial. Eur Urol 2008;53:160-6. DOI: https://doi.org/10.1016/j.eururo.2007.08.036

16. Thomas JA, Tubaro A, Barber N, et al. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for benign prostatic obstruction: two-year outcomes of the GOLIATH study. Eur Urol 2016;69:94-102. DOI: https://doi.org/10.1016/j.eururo.2015.07.054

17. Capitán C, Blázquez C, Martin MD, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol 2011;60:734-9. DOI: https://doi.org/10.1016/j.eururo.2011.05.043

18. Sønksen J, Barber NJ, Speakman MJ, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol 2015;68:643-52. DOI: https://doi.org/10.1016/j.eururo.2015.04.024

19. Gratzke C, Barber N, Speakman MJ, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 2017;119:767-75. DOI: https://doi.org/10.1111/bju.13714

20. Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol 2017;24:8802-13.

21. McVary KT, Rogers T, Roehrborn CG. Final 5-year outcomes of the multicenter randomized sham-controlled trial of water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2021;206:715-24. DOI: https://doi.org/10.1097/JU.0000000000001778

22. Amparore D, Fiori C, Valerio M, et al. 3-Year results following treatment with the second generation of the temporary implantable nitinol device in men with lower urinary tract symptoms secondary to benign prostatic obstruction. Prostate Cancer Prostatic Dis 2021;24:349-57. DOI: https://doi.org/10.1038/s41391-020-00281-5

23. Chughtai B, Elterman D, Shore N, et al. The iTind temporarily implanted nitinol device for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a multicenter, randomized, controlled trial. Urology 2021;153:270-6. DOI: https://doi.org/10.1016/j.urology.2020.12.022

24. Gilling P, Barber N, Bidair M, et al. WATER: a double-blind, randomized, controlled trial of Aquablation versus transurethral resection of the prostate in benign prostatic hyperplasia. J Urol 2018;199:1252-61. DOI: https://doi.org/10.1016/j.juro.2017.12.065

25. Oumedjbeur K, Corsi NJ, Bouhadana D, et al. Aquablation versus transurethral resection of the prostate: 5-year outcomes of the WATER randomized clinical trial. Can J Urol 2023;30:11504-10. DOI: https://doi.org/10.1016/S0302-2838(23)01169-7

26. Bhojani N, Bidair M, Kramolowsky E, et al. Aquablation therapy in large prostates (80-150 mL) for lower urinary tract symptoms due to benign prostatic hyperplasia: final WATER II 5-year clinical trial results. J Urol 2023;210:143-53. DOI: https://doi.org/10.1097/JU.0000000000003483

27. Berjaoui MB, Nguyen DD, Almousa S, et al. WATER versus WATER II 5-year update: comparing Aquablation therapy for benign prostatic hyperplasia in 30-80 mL and 80-150 mL prostates. BJUI Compass 2024;5:1125-33. DOI: https://doi.org/10.1002/bco2.430

28. Pisco JM, Bilhim T, Costa NV, et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol 2020;77:354-62. DOI: https://doi.org/10.1016/j.eururo.2019.11.010

29. Müllhaupt G, et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 5-year outcomes of a randomised trial. Eur Urol Focus 2024;10:1025-33. DOI: https://doi.org/10.1016/j.euf.2024.03.001

30. Gauhar V, Gómez Sancha F, Enikeev D, et al. Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate by evaluating current practice patterns and outcomes. World J Urol 2023;41:2991-3001. DOI: https://doi.org/10.1007/s00345-023-04626-2

31. Pirola GM, Castellani D, Naselli A, et al. Endoscopic enucleation of the prostate in men aged 80 years and older: outcomes from a global, large, multicenter series using different energy sources and techniques. World J Urol 2025;43:344. DOI: https://doi.org/10.1007/s00345-025-05699-x

32. Giulioni C, Tallè M, Papaveri A, et al. The implementation of Trifecta score to assess the quality of holmium laser enucleation of the prostate in elderly patients: an analysis of perioperative and functional outcomes and the impact of age. J Clin Med 2025;14:3410. DOI: https://doi.org/10.3390/jcm14103410

33. Tallè M, Giulioni C, Papaveri A, et al. Influence of preoperative indwelling urinary catheter on outcomes of high-power holmium laser enucleation for very large prostate (≥200 mL). World J Urol 2025;43:223. DOI: https://doi.org/10.1007/s00345-025-05624-2

34. Giulioni C, Falsetti F, Tallè M, et al. Impact of preoperative catheter duration on perioperative safety and functional outcomes following holmium laser enucleation of the prostate. Low Urin Tract Symptoms 2025;17:e70039. DOI: https://doi.org/10.1111/luts.70039

35. Briganti A, Naspro R, Gallina A, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 2006;175:1817-21. DOI: https://doi.org/10.1016/S0022-5347(05)00983-3

36. Roper C, Slade A, Caras R, et al. Ejaculatory and erectile function outcomes following holmium laser enucleation of the prostate. Prostate 2024;84:791-6. DOI: https://doi.org/10.1002/pros.24697

37. Leonardi R. Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation-sparing technique. Prostate Cancer Prostatic Dis 2009;12:277-80. DOI: https://doi.org/10.1038/pcan.2009.5

38. Leonardi R. The LEST technique: treatment of prostatic obstruction preserving antegrade ejaculation in patients with benign prostatic hyperplasia. Arch Ital Urol Androl 2019;91:35-42. DOI: https://doi.org/10.4081/aiua.2019.1.35

39. Leonardi R, Mantica G, Ambrosini F, et al. Diode laser enucleation of the prostate for benign prostatic hyperplasia: outcomes of the Leonardi ejaculation-sparing technique. Arch Ital Urol Androl 2025;97:14296. DOI: https://doi.org/10.4081/aiua.2025.14296

40. Eliwa A, et al. Randomized prospective trial comparing ejaculatory preservation holmium laser enucleation of the prostate versus standard holmium laser enucleation. World J Urol 2025;43:113. DOI: https://doi.org/10.1007/s00345-024-05418-y

41. McVary KT, Gange SN, Shore ND, et al. Treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med 2014;11:279-87. DOI: https://doi.org/10.1111/jsm.12333

42. Porto JG, Bhatia AM, Bhat A, et al. Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials. World J Urol 2024;42:639. DOI: https://doi.org/10.1007/s00345-024-05332-3

43. Ahyai SA, Gilling P, Kaplan SA, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 2010;58:384-97. DOI: https://doi.org/10.1016/j.eururo.2010.06.005

44. Cornu JN, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015;67:1066-96. DOI: https://doi.org/10.1016/j.eururo.2014.06.017

45. Castellani D, Cormio A, Alberti A, et al. Incidence of overactive bladder symptoms and dysuria following transurethral interventions for benign prostatic enlargement: a systematic review and meta-analysis of comparative and randomized studies. Neurourol Urodyn 2025;44:1676-88. DOI: https://doi.org/10.1002/nau.70129

46. Giulioni C, Cafarelli A, Piazza P, et al. Efficacy and safety of endourological surgery for managing overactive bladder symptoms in benign prostatic hyperplasia: a systematic review and meta-analysis. Int Neurourol J 2026;30:44-56. DOI: https://doi.org/10.5213/inj.2550188.094

47. Wroclawski ML, Takemura LS, Santos HOD, et al. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: systematic review and meta-analysis. Neurourol Urodyn 2024;43:126-43. DOI: https://doi.org/10.1002/nau.25336

48. Manfredi C, García-Gómez B, Arcaniolo D, et al. Impact of surgery for benign prostatic hyperplasia on sexual function: a systematic review and meta-analysis of erectile and ejaculatory function. Eur Urol Focus 2022;8:1711-23. DOI: https://doi.org/10.1016/j.euf.2022.06.007

49. Ramez M, Abolazm AE, El-Nahas AR. Ejaculatory-sparing transurethral prostatectomy: a meta-analysis of randomized controlled trials. Sex Med Rev 2024;12:754-60. DOI: https://doi.org/10.1093/sxmrev/qeae054

50. Calarco A, Viscuso P, Filippi B, Leonardi R, Mantica G, Magazzino C, Tufano A. "Z" Anatomical Needle Cut Leads Ejaculation (ZANCLE): Unilateral incision for bladder neck obstruction with ejaculation-sparing intent: A single-surgeon experience. Urologia. 2025 Aug;92(3):466-469. doi: 10.1177/03915603251334084. Epub 2025 Apr 17. PMID: 40243909. DOI: https://doi.org/10.1177/03915603251334084

51. Giulioni C, Cafarelli A, Falsetti F, et al. Ejaculation-sparing endoscopic surgery for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2026;44:295. DOI: https://doi.org/10.1007/s00345-026-06397-y

52. Scarcella S, Castellani D, Gauhar V, et al. Robotic-assisted versus open simple prostatectomy: results from a systematic review and meta-analysis of comparative studies. Investig Clin Urol 2021;62:631-40. DOI: https://doi.org/10.4111/icu.20210297

53. Tan C, Wang C, Huang J, et al. Comparative outcomes of holmium laser enucleation of the prostate versus robotic-assisted simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis. J Robot Surg 2025;19:478. DOI: https://doi.org/10.1007/s11701-025-02577-x

54. Schumacher S, Marghawal D, Brunken C, et al. Patient reported outcome and quality of life measured by a simple questionnaire in patients with symptomatic benign prostate hyperplasia treated by holmium laser enucleation of the prostate (HoLEP). Front Surg 2024;11:1358701. DOI: https://doi.org/10.3389/fsurg.2024.1358701

55. Gauhar V, Yuen SKK, Gadzhiev N, et al. Optilume, a minimally invasive solution for benign prostatic hyperplasia and urethral stricture: what we know, what we need? An EAU Endourology scoping review. BMC Urol 2025;25:196. DOI: https://doi.org/10.1186/s12894-025-01896-3

56. Leonardi R, Ambrosini F, Malinaric R, et al. New minimally invasive solutions for benign prostatic obstruction management: a position paper from the UrOP. Arch Ital Urol Androl 2023;95:12003. DOI: https://doi.org/10.4081/aiua.2023.12003

57. Winograd J, Kindler R, Lleras C, et al. Quality of life and surgical treatment regret in patients with benign prostatic hypertrophy: a multicenter study. Can J Urol 2025;32:219-27. DOI: https://doi.org/10.32604/cju.2025.064404

58. Dimitri M, Calarco A, Filippi B, et al. I-Tind for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: Mid-term outcomes from a multicenter cohort. Urologia. 2025;92:693-697. DOI: https://doi.org/10.1177/03915603251360530