Association between health literacy and acceptance or refusal of surgical treatment in patients with benign prostatic obstruction

Introduction This study investigated the association between health literacy and acceptance of surgery for benign prostatic obstruction (BPO).Material and methods In this prospective observational study, 95 patients recommended surgery for BPO (May–September 2025) were classified as accepting (n = 61) or refusing (n = 34) surgery. Health literacy was assessed using the HLS-EU-Q47. Clinical characteristics and International Prostate Symptom Scores (IPSS) were compared.Results Age, education, marital status, overall comorbidity prevalence, medical treatment duration, and uroflowmetry parameters did not differ significantly between groups. Smoking history (p < 0.001) and coronary artery disease (p = 0.002) differed significantly. Patients accepting surgery had higher IPSS scores (p < 0.001). Overall ASOY-TR health literacy scores were similar (p = 0.359), although health literacy category distributions differed (p = 0.035). In multivariable analysis, IPSS (adjusted OR = 1.158, p < 0.001) and family history of BPO surgery (adjusted OR = 3.725, p = 0.020) were independently associated with acceptance; the ASOY-TR index was not (adjusted OR = 1.036, p = 0.326).Discussion Health literacy was not independently associated with surgical acceptance. Symptom severity and family history were associated with acceptance, underscoring their relevance to shared decision-making.