Following BPH procedures, retreatment rates due to recurrent obstruction are lowest with the greatest extent of adenoma removed and can increase with time from treatment as occlusive tissue regrows. Procedural retreatment (see Appendix III) has been characterized in multiple systematic reviews and retrospective studies.257-260 However, most data for minimally invasive treatments included in such reviews consists of clinical trial cohorts, which are often relatively homogenous with regard to patient characteristics, on account of the strict inclusion and exclusion criteria used in pivotal studies. The relatively small groups of urologists participating in these trials also limit their generalizability. This results in an overall limited applicability of these findings outside of the narrow segment of the population in which the studies were performed, however, it may also represent a “best case scenario” for patients that fit those specific criteria. Overall, individual results with these treatments may vary compared to those obtained in their pivotal clinical trials. On the other hand, studies with less restrictive enrollment criteria due to more broadly applicable procedures (i.e., HoLEP) will instead generate data that better reflects “real world” experiences. This may result in a broader range of outcomes for these procedures, which can be further reflected in the heterogeneity of urologists and sites who have conducted such studies. Medical retreatment (see Appendix IV) has been less well-defined by structured reviews and primary literature, which likely makes the data in these reviews more reflective of heterogeneous patient populations and urologists involved in these studies.257, 261-263 Nonetheless, it is likely that surgeries fully enucleating the prostate offer the most durable results with the lowest retreatment rates, whereas procedures that reposition tissue or induce gradual tissue necrosis have the highest retreatment rates. The ability to achieve durable results, as evidenced by low retreatment rates, is often balanced against a greater risk of side effects (i.e., EjD, urinary incontinence, stricture). Furthermore, considering the breadth of procedures available, retreatment rates are also likely impacted by using specific interventions in certain prostate morphologies (i.e., shapes and sizes).