Boston Scientific Revises 2026 Guidance Due to EP, WATCHMAN, and Urology Headwinds

Reasons Boston Scientific revised its 2026 revenue and EPS guidance (headwinds in EP WATCHMAN Urology)

Boston Scientific said the company is guiding to lower 2026 growth and EPS because it is facing “unanticipated headwinds and changing business patterns” and explicitly attributes the guide-down to three primary contributors: EP, WATCHMAN, and Urology. ¹²³

1) EP headwinds: slower growth in U.S. EP despite strength elsewhere

Management noted that EP had a “very nice first quarter” and is confident about PFA leadership (i.e., it expects to maintain market position), but still reduced the overall EP/Urology-related outlook to be “prudent” given competitive dynamics and share erosion that is greater than previously anticipated. ²⁴⁵

Key elements in the EP rationale:

• Share erosion / increased competition: Management stated that they are now seeing increased competition (Medtronic, J&J, and Abbott), which implies more share erosion than anticipated earlier; they still expect PFA leadership, but at a lower growth rate than earlier guidance. ⁵
• U.S. WATCHMAN/EP practice shifts spill into EP demand pattern expectations: Management also described that practice patterns are changing as WATCHMAN/ablation adoption evolves (more shift toward EP physicians and concomitant procedures vs stand-alone), which affects how growth translates into EP-related demand over time and complicates forecasting. ⁶

While the excerpt does not provide a numeric “EP headwind” amount separate from the overall guidance reduction, the EP-related guidance change is embedded in the updated 2026 growth outlook and the stated drivers (EP/WATCHMAN/Urology). ¹²³

2) WATCHMAN headwinds: deceleration of volume—stand-alone pressure after concomitant adoption

Although the question focuses on “EP WATCHMAN Urology,” Boston Scientific’s revision is closely tied to WATCHMAN volume trends, and management described a clear pattern: strong momentum earlier followed by softening that began in February.

Specifically:

• Declining WATCHMAN volume started mid/late-Q1: Management said there was no signal of weakness until early to mid-February, when WATCHMAN volume declined for the first time. ²
• Concomitant growth increased while stand-alone WATCHMAN decelerated: They attributed the change to a “strong increase in concomitant growth” alongside a deceleration of stand-alone WATCHMAN. ²
• Stand-alone cases pressured by operational and reimbursement factors: Management later elaborated that WATCHMAN pressure in the U.S. as the quarter progressed reflected annualization of initial concomitant adoption, plus softening in stand-alone cases driven by hospital capacity prioritization and evolving reimbursement dynamics. ⁷
• Guidance adjustment assumption: Management indicated it is prudent to assume the deceleration continues into the guidance period—implying the guide-down embeds this expected ongoing pattern through the remainder of 2026. ²

WATCHMAN’s deceleration matters because Boston Scientific treats WATCHMAN and EP as connected growth engines through shared electrophysiology and cardiology workflows; thus, the WATCHMAN volume outlook directly supports the need for revised revenue and EPS guidance. ²⁷

3) Urology headwinds: weak Q1 stone management and neuromodulation impacts expected to keep 2026 below “market”

Boston Scientific’s biggest explicit “Urology” headwind description is that it had a difficult Q1, with 1% organic growth for urology (below expectations), driven primarily by stone management and single neuromodulation businesses. ⁸⁹

The revised guidance logic for Urology included:

• Q1 urology underperformance: Urology sales grew only ~1% organically in Q1 and fell short of expectations. ⁹
• Primary drivers of weakness: Management said stone underperformance was driven by China VBP and product gaps in the core stone portfolio. ⁹
• Neuromodulation impact in urology-related areas: Management also referred to difficulties in neuromodulation/“Pelvic Health” commercial model disruption and expected improvement later, but still guided to low-to-mid single-digit Uro growth for 2026. ¹⁰³
• Below-market year expectation: Management stated urology is “essentially going to be a below market year in urology” as it executes plans to fix neuromodulation issues and introduces product launches impacting the business in later periods (with benefits expected more toward 2027). ³

These Urology issues are directly cited as part of the three primary contributors behind the guidance reduction. ²³

---

How these headwinds flowed into the guidance revision (revenue and EPS)

Boston Scientific reduced its 2026 guidance to reflect these EP/WATCHMAN/Urology headwinds and updated expected growth rates and EPS:

• Management said 2026 is “more challenging than we initially expected” and therefore reduced full-year guidance to 6.5%–8% organic growth (from prior expectations), citing “unanticipated headwinds and changing business patterns.” ¹
• Updated full-year adjusted EPS guide was set at $3.34 to $3.41 (growth of 9% to 11%). ¹
• Guidance for Q2 also reflects the weaker outlook: second-quarter adjusted EPS of $0.82 to $0.84 and lower organic growth assumptions. ¹

Finally, management summarized that the guide-down is “focused on” EP, WATCHMAN, and Urology and that it is providing the changes as “prudent” to set expectations appropriately. ²³

---

Bottom line

Boston Scientific revised its 2026 revenue and EPS guidance because it expects slower growth than previously planned driven by:

1. EP-related competitive pressures and greater-than-expected share erosion (despite confidence in PFA leadership). ⁵
2. WATCHMAN deceleration after early strong growth—especially stand-alone case pressure alongside shifting practice patterns and operational/reimbursement dynamics. ²⁷
3. Urology weakness from stone management and neuromodulation headwinds (including China VBP, product gaps, and ongoing disruption), leading to a below-market urology year and only later improvement. ³⁹

These three items were explicitly described as the primary contributors to the guidance reduction. ²³