To quantify benign prostatic hyperplasia (BPH) patient preferences to promote guidelines-compliant, patient-centered care. Discordance between patient and urologist priorities for the treatment of BPH hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American Urologic Association guidelines urge urologists to consider patient preferences when recommending a BPH treatment.

In this cross-sectional, online survey study using researchmatch.org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated.

Out of 1235 recruited participants, 812 (66%) completed the study. Median International Prostate Symptom Score and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute, followed by efficacy, recovery difficulty, and risk of ejaculatory dysfunction. In a subgroup analysis of age quartiles, participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively.

Males valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction.