Incidence of Acute Urinary Retention/Failure to Void after Transurethral Interventions for Benign Prostatic Enlargement: Results from a Systematic Review and Meta-Analysis of Comparative Randomized Studies by the FUTURE Collaborative of the Endourological Society

Objective: To perform a systematic review and meta-analysis to assess the incidence of acute urinary retention (AUR)/failure to void after transurethral surgeries for benign prostatic enlargement, comparing Ablation, Enucleation, and Resection (TURP) techniques. Materials and Methods: A systematic literature search was performed on October 13, 2025 using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar TURP (M-TURP) or bipolar TURP (B-TURP) vs Ablation vs Enucleation procedures. Incidence of AUR/failure to void following the index surgery was evaluated using the Cochran–Mantel–Haenszel method and reported as risk ratio (RR), 95% confidence interval (CI), and p values. Statistical significance was set at p < 0.05. Evidence Synthesis: A total of 61 studies were included, with 1497 patients in the Enucleation, 2512 patients in the Ablation, and 4007 patients in the TURP groups. The pooled incidence of AUR/failure to void was 3.7% (72/1944 patients) after M-TURP, 3.0% (47/1553 patients) after B-TURP, 9.0% (226/2512 patients) after Ablation, and 2.4% (36/1497 patients) after Enucleation. Meta-analysis showed no significant difference between Enucleation and TURP (RR 0.90, 95% CI 0.61–1.32, p = 0.59; I 2 = 0%) in AUR/failure to void rate. Conversely, Ablation was associated with a significantly higher incidence of AUR/failure to void compared with TURP (RR 1.79, 95% CI 1.38–2.31, p < 0.001; I 2 = 22%). Subgroup analyses revealed that this difference persisted for diode laser (RR 4.53, 95% CI 1.24–16.47), monopolar electrovaporization (RR 3.24, 95% CI 1.90–5.55), and Neodymium (Nd):YAG laser/RR 2.61, 95% CI 1.54–4.42) ablation techniques. No significant difference was found between M-TURP, B-TURP, and Enucleation, and between B-TURP and Ablation. Conversely, AUR/failure to void incidence favored M-TURP over Ablation (RR 1.88, 95% CI 1.40–2.52, p < 0.001). Conclusions: Enucleation procedures demonstrate comparable safety to TURP regarding postoperative AUR/failure to void, whereas Ablation procedures are associated with a significantly higher incidence of postoperative retention events, particularly with energy modalities such as monopolar electrocautery, diode, and Nd:YAG lasers.