I was recently asked to review the case of Mr Jones, a 57-year-old man who brought a complaint against his local NHS hospital following surgery for benign prostate enlargement.
He had struggled for years with lower urinary tract symptoms and poor bladder emptying. Medications hadn’t helped. Scans showed a small middle lobe of the prostate pushing up into the bladder, and he was advised to undergo a transurethral resection of the prostate, or TURP. This is a well-established procedure approved by NICE and remains an effective treatment.
He was told that UroLift was offered at the hospital, but that it would not be suitable due to the shape of his prostate. He was counselled about the risk of dry orgasm, proceeded with surgery, and had a technically successful outcome. His urinary symptoms improved significantly.
Several months later, he discovered that a friend had undergone a different treatment called REZUM at a neighbouring hospital. Both men were happy with their urinary results. The difference was that Mr Jones developed a permanent dry orgasm, which occurs in around 65 to 75 percent of men after TURP. His friend did not experience any change in ejaculation. With REZUM, the risk of dry orgasm is closer to 4 to 5 percent.
On researching further, Mr Jones learnt that there are several NICE-approved procedures available within the NHS that carry a lower risk of ejaculatory dysfunction. These include UroLift, REZUM, Aquablation and GreenLight laser prostatectomy.
His solicitor later pointed out that had the surgeon explored how important ejaculation was to him, Mr Jones would have accepted a slightly lower chance of symptom improvement in order to preserve it.
Expert opinion agreed that surgery was appropriate and carried out to a high technical standard. However, the concern centred not on how the surgery was performed, but on the consent process itself.
The operating surgeon felt that he could not offer alternative procedures within his trust and that detailing every available option would make NHS consultations unmanageable. The claimant’s legal team argued that information sheets from NICE and the British Association of Urological Surgeons are readily available, and that patients can easily be directed to reputable resources to review their options, including detailed patient guides (link: https://prostatematters.co.uk/determining-suitable-bph-treatment-options/overview-of-treatments-for-benign-prostatic-hyperplasia-bph/) that explain the different treatments available.
The trust’s solicitors ultimately advised that there was a potential defect in informed consent, and the case was settled in Mr Jones’s favour.
We now practise in an era where multiple effective treatments often exist for the same condition. There is not always a single “best” option. In these situations, consent must go beyond simply recommending the procedure available locally.
Unless there is a clear risk of harm, patients should be made aware of reasonable alternatives, even if those options are not offered within that particular hospital.
Consent does not require listing every conceivable operation on a form. But it does require meaningful discussion about what matters to the individual patient. For some men, preserving ejaculation may be a priority. For others, maximum urinary improvement is the goal.
True patient-focused consent means understanding those priorities first.
Good outcomes start with good conversations. Modern medicine offers choice. The key is ensuring patients understand that choice and feel empowered to weigh the benefits and trade-offs for themselves. When consent is genuinely patient focused, treatment decisions become shared decisions and that is always the safest path forward.