It is now possible to reduce the risk of acute urinary retention (AUR) and prostate surgery in patients suffering from symptomatic benign prostatic hyperplasia (BPH) with medical therapy. The objective of this study was to determine the concern and perceived impact on quality of life (QoL) of these potential events in patients at risk. Seventy-four consecutive patients with a diagnosis of BPH, but no history of AUR or prostate surgery referred to a single urology practice completed an AUA/BPH symptom index (AUA-SI), AUA BPH impact index, QoL assessment, and a comprehensive questionnaire (before and after counseling). This questionnaire explored their concern and opinion regarding the perceived impact of AUR or surgery on their personal QoL. Sixty-two patients (mean age 69.5) with an average AUA BPH Symptom Index of 12.2 were eligible for analysis. Over half of the patients were significantly concerned about the prospect of AUR (57%) and two thirds of the patients (67%) were significantly concerned about the prospect of surgery. However, more patients considered the insertion of a catheter for acute urinary retention would be more detrimental to their quality of life than surgery (68% vsersus 45%). More patients believed that catheterization would be more of a problem in their life than surgery (69% versus 52%). Patients with BPH at risk for future acute urinary retention and surgery generally felt that the potential occurrence of these events were of a major concern and if they occurred would be an important event affecting their personal quality of life.