When BPH treatments fail
As the global burden of BPH continues to rise, urology experts are sounding the alarm about the increasing frequency of treatment failures.
As the global burden of benign prostatic hyperplasia (BPH) continues to rise, urology experts are sounding the alarm about a growing challenge: the increasing frequency of treatment failures after traditional surgeries and newer minimally invasive procedures. The issue will take center stage during an upcoming panel discussion, When BPH Treatments Fail: Why and What Next? at the 2026 AUA Annual Meeting. The session is being led by Kevin T. McVary, MD-FACS, a professor of urology at Loyola University Stritch School of Medicine in Chicago and president of the Society of Benign Prostate Disease (SoBPD).
According to Dr. McVary, treatment failure—manifesting as recurring lower urinary tract symptoms (LUTS)—is far more common than many realize. Even after what are considered definitive surgical interventions, patients frequently return with persistent or recurrent symptoms.
“All known traditional surgical and minimally invasive (MIST) treatments for LUTS/BPH carry a risk for recurrence. In this session, we will concentrate our efforts to unveil why surgery and minimally invasive treatments (MISTs) may fail, both in the short- and long-term,” Dr. McVary said
Traditional and more recent therapies for LUTS/BPH retreatments that carry a risk for recurrence include Urolift, Rezum, Aquablation, HoLEP and TURP, he said. As such, treatment success often hinges on certain patient criteria, which can influence how well a chosen intervention will relieve obstruction, Dr. McVary said. Additionally, some therapies have inherent limitations that make them less effective in men with certain anatomical profiles.
“Remembering the limitations of each therapy to control symptoms based on patient phenotype (i.e., prostate volume, prostate conformation) is an important aspect to be explored for each of the interventions,” he said. “We’ll also discuss modifiable risk factors influencing LUTS that may be better handled by alternate nonsurgical means.”
Those modifiable risk factors include lifestyle, comorbidities and behavioral contributors to urinary symptoms. If these are not addressed, they can result in an incomplete response to surgical or procedural treatments, he said.
Before considering retreatment, Dr. McVary urges urologists to reevaluate the underlying pathophysiology and understand exactly why the initial therapy failed. The session will outline diagnostic strategies and preretreatment evaluation tools that help clinicians avoid repeating ineffective approaches, he said.
Remember, he said, that treatment failure doesn’t just affect urinary function. When failure occurs, it feels personal for the patient.
“There is little debate that a failed LUTS/BPH is a major detriment to a man’s quality of life. Men with LUTS/BPH have numerous surgical options. However, the abundance of choices can lead to anxiety, decision fatigue and regret after choosing. I call it the ‘paradox of choice,’” he said. “There are financial impact factors, specific adverse events, and in some cases, permanent impact to the man’s sense of well-being that drive the negative influence on quality of life. So, we’ll also explore the emerging concept of surgery treatment regret.”
Beyond individual patients, Dr. McVary warns that the world is facing an unprecedented surge in BPH cases. As life expectancy rises and lower-income countries overcome fatal infectious diseases, more men are living long enough to develop LUTS/BPH. Yet the urological workforce is not growing at the same pace, creating a widening gap between patient need and specialist availability.
“The burden of LUTS/BPH now exceeds that of all urological cancers combined,” he said.
This mismatch will soon strain health care systems worldwide, Dr. McVary said, making it more important to access the resources offered by professional organizations, including the Society of Benign Prostate Disease and the AUA.
“These organizations can help make the future care of patients less burdensome and even preventable,” he said.
