Background: Benign prostatic hyperplasia (BPH) is a common age-related condition causing lower urinary tract symptoms (LUTS) and bladder outlet obstruction. Acute urinary retention (AUR) represents an important complication and may indicate advanced obstruction, impaired bladder function and increased perioperative morbidity. Transurethral resection of the prostate (TURP) remains an established surgical treatment. This study compared postoperative outcomes and complications following TURP in BPH patients presenting with and without AUR.

Methods: A prospective observational comparative study was conducted at a tertiary care medical college and hospital in Maharashtra from April 2024 to March 2026. Seventy-four patients were studied, with 37 patients in the AUR group and 37 in the non-AUR group. Eligible men were aged 55–75 years, had moderate-to-severe LUTS, prostate size >30–110 g and Qmax <10 mL/s. Patients with urethral stricture, neurogenic bladder, previous prostate/urethral surgery, prostate cancer or unwillingness to participate were excluded. All patients underwent TURP under regional anaesthesia and were followed at 1 week, 2 weeks and 1 month. Outcomes included IPSS, Qmax, PVR, postoperative complications and hospital stay.

Results: The AUR group was older (67.8±5.4 vs 64.9±5.8 years; p=0.032), had larger prostates (70.6±8.9 vs 53.2±7.5 g; p<0.001), higher PSA (5.82±1.21 vs 4.36±0.98 ng/mL; p<0.001), higher preoperative IPSS (24.6±3.2 vs 19.8±2.9) and poorer baseline urinary flow with greater PVR. Operative duration was longer in AUR patients (62.4±8.6 vs 54.1±7.3 min). Postoperative UTI (29.7% vs 13.5%; p=0.048) and recatheterization (21.6% vs 8.1%; p=0.046) were significantly more frequent in AUR patients. Mean hospital stay was longer (5.8±1.4 vs 4.2±1.1 days; p<0.001). At one month, AUR patients had higher IPSS (7.8±1.9 vs 6.5±1.6; p=0.004), lower Qmax (16.2±2.8 vs 18.5±3.1 mL/s; p=0.002) and higher PVR (42.6±12.3 vs 28.4±9.7 mL; p<0.001).

Conclusion: TURP produced functional improvement in both groups. However, patients presenting with AUR had greater baseline disease burden, higher infection and recatheterization rates, longer hospitalization and relatively slower early functional recovery. AUR should therefore be regarded as an important marker of advanced disease and a factor requiring careful perioperative optimization and counselling.