INTRODUCTION: Benign prostatic hypertrophy (BPH) is a common condition affecting men later in life, significantly impacting quality of life (QOL). Surgical intervention is often pursued when medical management fails, but patient satisfaction with outcomes varies. Decisional regret can affect perceived success and patient satisfaction post-surgery. This study evaluates the relationship between post-surgical symptoms and decisional regret across BPH procedures. METHODS: A prospective, multicenter cohort study included 54 patients undergoing BPH surgery between March 2023 and February 2024. Patients completed the International Prostate Symptom Score-QOL (IPSS-QOL) scale preoperatively and at least three months postoperatively, along with the Decision Regret Scale (DRS). Surgical types included Urolift, Greenlight Laser, Rezum, Aquablation, and transurethral resection of the prostate (TURP). A DRS score of ≥25 indicated significant regret. Changes in IPSS-QOL were correlated with DRS scores (Spearman's rho), and subgroup comparisons were conducted using Mann-Whitney U tests. RESULTS: The average DRS score was 18.3, with 33% of patients reporting a DRS ≥25. Moderate correlations existed between quality of life (QOL) change (ρ = 0.34, p < 0.05) and total regret score. Minimally invasive surgical treatment (MISTs) patients demonstrated higher regret correlations than TURP. Lack of efficacy (75%), new symptoms (41%), and postoperative complications (25%) were the most common reasons for regret. CONCLUSION: While BPH surgery generally improves symptoms, a substantial portion of patients experience decisional regret. This underscores the importance of preoperative counseling to establish realistic expectations and reduce regret. Further research should explore strategies to enhance shared decision-making and align patient expectations with possible surgical outcomes.