Real-world outcomes of transurethral resection of the prostate: a Portuguese cohort.

BACKGROUND: Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms and bladder outlet obstruction in ageing men. Transurethral resection of the prostate remains a benchmark surgical treatment, although contemporary practice has been challenged by less invasive techniques. We aimed to evaluate real-world effectiveness and safety outcomes of transurethral resection of the prostate for benign prostatic obstruction. MATERIALS AND METHODS: Single-center, retrospective, observational cohort study including all consecutive patients who underwent TURP between October 2020 and March 2025. Baseline, perioperative and postoperative variables were analyzed, including 30-day emergency department (ED) visits, catheter-free status among previously catheterized patients, persistence of lower urinary tract symptoms (LUTS), and uroflowmetry parameters. RESULTS: A total of 530 patients were included (median age 69 years). Median hospitalization was 2 days, with 15.7% discharged within 24 hours. Within 30 days, 109 patients (20.6%) attended the ED, mainly due to acute urinary retention (39.4%) and hematuria (31.2%); perioperative hemoglobin drop was the only independent predictor of ED attendance (OR 1.267; p = 0.004). Among chronically catheterized patients, 89.4% became catheter-free postoperatively. Prostate volume was independently associated with longer hospitalization and persistent postoperative LUTS. Antithrombotic monotherapy was not significantly associated with greater hemoglobin drop, catheterization duration, or ED attendance. Maximum urinary flow rate improved significantly from 8.20 to 19.47 mL/s (p < 0.001). CONCLUSIONS: This real-world cohort confirms TURP as an effective and safe procedure for benign prostatic obstruction, providing objective functional improvement and a high catheter-free rate. ED visits, mainly due to urinary retention and hematuria, represent a relevant target for pathway optimization. Standardized antithrombotic protocols and structured postoperative follow-up may further improve safety and quality of care.