Predictors of early surgical treatment after a first episode of acute urinary retention due to benign prostatic obstruction: a single-center retrospective cohort study.

PURPOSE: To identify clinical, biochemical, and radiological factors associated with progression to early surgical treatment after a first episode of acute urinary retention (AUR) secondary to benign prostatic obstruction. METHODS: This single-center retrospective cohort study included 425 patients with a first episode of AUR between 2020 and 2026, managed with catheterization, alpha-blocker therapy, and a trial without catheter. Patients were categorized into medical management (n = 197) and surgical treatment (n = 228) groups. Univariable and multivariable logistic regression analyses identified factors associated with progression to surgery. Discrimination was assessed by ROC analysis, and the final model underwent bootstrap internal validation with 1,000 resamples and calibration assessment. RESULTS: All evaluated variables were associated with surgical treatment in univariable analysis (all p < 0.001). In multivariable analysis, prostate volume, retention volume, serum urea, and IPSS remained independently associated with progression to surgery (all p < 0.05). IPP was also associated after adjustment (OR 3.409, 95% CI 1.007-11.542; p = 0.046), although the estimate was imprecise. IPSS showed the highest discriminative performance (AUC 0.941), followed by retention volume (AUC 0.907). The final model showed an apparent AUC of 0.980 and an optimism-corrected AUC of 0.959; the Brier score was 0.0404. CONCLUSION: Prostate volume, IPSS, retention volume, and serum urea were independently associated with progression to surgery after a first AUR episode. IPSS and retention volume showed the greatest discriminative performance. IPP may provide additional prognostic information, but its imprecise estimate warrants cautious interpretation. These routinely available parameters may support early risk stratification, pending external validation.