Evaluate the influence of clinical, radiological, and urodynamic parameters on surgical decision making and technique selection for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS-BPH) among Brazilian urologists.

An electronic 23-item survey was distributed to 3,000 members of the Brazilian Society of Urology. The questionnaire included demographic data, clinical scenarios, and questions regarding treatment preferences. Responses were analyzed using descriptive statistics, chi-square or Fisher’s exact test, and logistic regression models. The study was approved by an institutional ethics committee, and electronic informed consent was obtained.

A total of 602 urologists responded (20.1% response rate). Respondents were predominantly male (94%) with a median age of 47 years (IQR: 40–57). Transurethral resection of the prostate (TURP) was the most frequently performed procedure (93%), followed by open simple prostatectomy (37%). In a scenario with detrusor underactivity, 9.8% deferred surgery, and TURP preference decreased from 63.2% to 45.3%, while EEP increased from 29.6% to 36.8% (p = 0.009). Younger urologists were more likely to recommend surgery despite detrusor underactivity (OR: 1.79, p < 0.001). Among patients with well-controlled LUTS, structural abnormalities (e.g., rising post-void residual, bladder diverticulum) prompted surgical consideration in approximately 50% of respondents. Routine use of urodynamics before BPH surgery was reported by only 13.9%.

This survey highlights the diverse ways in which clinical, radiological, and urodynamic factors shape self-reported surgical decision-making in LUTS/BPH scenarios. As surgical options continue to expand, understanding these decision drivers may help inform educational initiatives and future guideline discussions, and should be complemented by real-world studies to confirm how these preferences translate into clinical practice.