Benign prostatic hyperplasia (BPH) represents a prevalent condition in the male population, increasing from 8% in men aged 31–40 yr to over 80% in men older than 80 yr [1]. The incremental financial burden related to a diagnosis of BPH is roughly $1500 per year in the USA, contributing to the overall estimated annual cost of treating BPH of approximately $4 billion [2].

Surgical treatment represents one of the cornerstones of BPH management; in this context, transurethral resection of the prostate (TURP) has long represented the gold standard due to its widespread availability and efficacy [3]. Nevertheless, an increasing number of novel surgical treatments (NSTs) have been proposed over time to achieve similar functional outcomes, but better perioperative and sexual outcomes than traditional procedures [4]. Their possible administration under local anesthesia and/or sedation in an outpatient or in-office setting represents a cost-saving alternative for the US health system [5], [6]. The surgical techniques adopted for BPH treatment do not involve the removal of the entire gland, exposing the patients to the risk of regrowth of prostatic tissue with the need for retreatment. The surgical retreatment rate varies between 2% and 6% depending on the treatment modality considered and the follow-up time [7].

Although results from randomized controlled trials (RCTs) are regarded as the highest level of evidence, pooled large-volume data from national registries offer valuable insights into the real-world adoption of surgical techniques. In the present population-based analysis, we aimed to assess the trends in the utilization and costs of various BPH surgical procedures over the last decade. In addition, we sought to evaluate and compare the need for surgical retreatment after different BPH surgeries.