Back to 2026 Abstracts
Post-HoLEP Decisional Regret: A Mixed-Methods Analysis
Benjamin Greenfield, BS, MS1, Mubarak Momodu, BA2, Feres Maluf, MD3, Lynn Leng, MS2, Ethan Wan, MPH2, Vicente E. Decombe, MD3, Joel T. Funk, MD3, Kazumi Taguchi, MD3, Karishma Gupta, MD3, Max Bowman, MD2, Thomas Chi, MD3.
1Tufts University School of Medicine, Boston, MA, USA, 2University of California, San Francisco, San Francisco, CA, USA, 3University of Alabama at Birmingham, Birmingham, AL, USA.
BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is an effective treatment for benign bladder outlet obstruction, but a subset of patients experience decisional uncertainty or regret after surgery. This study evaluated the frequency, predictors, and lived experiences of post-HoLEP decisional regret.
METHODS: This single-institution mixed-methods study included adults who underwent HoLEP between 2017 and 2023 and completed the Surgical Satisfaction Questionnaire (SSQ-8). Decisional uncertainty or regret was defined as answering “unsure,” “don't think so,” or “never” to whether the patient would choose HoLEP again. Multivariable logistic regression was used to identify clinical predictors. Fifteen patients with regret-related responses underwent semi-structured interviews and completed the Decisional Regret Scale (DRS); their DRS scores were compared with those of age-matched controls.
RESULTS: Among 471 patients, 256 (54.4%) completed the SSQ-8, and 46 (18.0%) reported decisional uncertainty or regret. Interviewed patients had significantly higher overall DRS scores than controls (61.7 ± 14.7 vs 8.1 ± 16.3; p<0.001). Significant predictors of regret included post-operative incontinence at 1 year (OR 4.79, p<0.01), longer time elapsed since surgery (OR 1.34, p=0.02), and need for a secondary procedure (OR 4.13, p=0.04). Preoperative catheter dependence was protective (OR 0.39, p=0.05). Qualitative analysis identified five major themes: new or persistent symptoms, reduced quality of life, incomplete information, poor communication with the medical team, and negative emotions associated with regret.
CONCLUSIONS: Nearly one in five patients reported decisional uncertainty or regret after HoLEP. Regret was associated with symptom burden, especially long-term incontinence, as well as communication and shared decision-making concerns. Improving counseling, expectation-setting, and postoperative communication may reduce regret and improve patient satisfaction after HoLEP.
Back to 2026 Abstracts
