Men with catheter-dependent urinary retention caused by obstruction from benign enlargement of the prostate can benefit from surgical intervention to relieve their retention. Resective technologies are those that actively remove prostate tissue at the time of surgery and effectively debulk the prostate. In a systematic review and meta-analysis, Law et al. evaluated the outcomes of men undergoing surgical intervention for BPH with only symptomatic LUTS versus those in urinary retention.428 They included 25 studies with 14,593 patients of whom 6,766 had preoperative urinary retention and 7,827 had only symptomatic LUTS. The surgical interventions used in these studies included TURP,429-440 PVP,432, 441-447 HoLEP,448-450 TUVP,451 bipolar enucleation of the prostate,452 and TUMT.453 They found similar IPSS and Qmax for both groups at 6 and 12 months postoperatively suggesting the ability of bladder function to recover in patients with urinary retention caused by BPH. However, men in urinary retention had higher risk of immediate transient re-catheterization (RR: 5.29; p<0.00001), longer days to trial-off-catheter (MD: 0.25 days; p<0.00001), longer length of stay (MD: 0.35 days; p<0.00001), higher risk of intraoperative blood transfusions (RR: 1.90; p=0.002), postoperative UTIs (RR: 1.49; p<0.00001), and sepsis (RR: 8.15; p=0.009). This study suggests that patients with BPH and preoperative urinary retention have poorer short-term outcomes but similar long-term functional outcomes. Limitations of this study include the heterogeneity of the included studies, variability of the surgical intervention performed, and inability to account for patient comorbidities and prostate volume. In a recent study by Burton et al., they evaluated the outcomes of RWT in men with acute and chronic urinary retention (PVR >300 mL).454 Of the 113 men who had RWT, 28 had AUR and 16 had chronic retention. Patients with preoperative acute or chronic retention had a higher rate of failing first trial of void compared to those without retention (40% AUR versus 12.5% chronic retention versus 7.2% no retention; p<0.001). However, at a mean of 5-month follow-up, 98% of men with acute and chronic retention were voiding spontaneously and there was no difference in IPSS or uroflowmetry between the groups. Johnsen et al. compared outcomes of HoLEP in men with and without preoperative urinary retention.449 Patients with retention were older, had larger prostates, and higher pre-retention AUA-SS and bother scores (p<0.05). Both groups demonstrated significant improvement in subjective and objective voiding measures (i.e., AUA-SS, bother score, Qmax, PVR) without a difference in the rate of complications. There was no difference between the groups in the rate of postoperative urinary retention, and no patients required long-term catheterization. An explanation for the efficacy of HoLEP in men with urinary retention is likely the volume of prostate tissue removed (mean: 74.1±62.6 g). Additional studies have reported similar efficacy of HoLEP in patients with BPH and urinary retention.450, 455 An important consideration in men with catheter-dependent urinary retention caused by obstruction from BPH is the presence of underlying DU. UDS may be considered in these patients to assess detrusor function with a BCI <100 which can be evidence of impaired contractility.456 In these patients, relief of urinary retention may be dependent on reducing urethral resistance. Resective technologies such as TURP, AEEP (i.e., HoLEP, ThuLEP), PVP, RWT, and simple prostatectomy are preferred as they provide immediate and maximal debulking of obstructing prostate tissue. Huang et al. reported that in men who underwent TURP for BPH with AUR, a higher resection ratio (the resected specimen weight divided by prostate volume) was the only predictor for catheterization status and postoperative BPH medication within 3 months.457 Lomas et al. evaluated the long-term outcomes of HoLEP in men with BPH and concurrent urodynamically-proven DU or acontractility.458 Postoperatively, 8 (88.9%) men with DU and 5 (62.5%) men with acontractility were catheter-free at median follow-up of 50.9 and 38.6 months, respectively. In a separate study by Mitchell et al., patients with DU and acontractile bladders undergoing HoLEP were evaluated with preoperative and postoperative UDS.235 At a median follow-up of 24.7 months, 100% of patients with DU and 18/19 (94.7%) men with acontractile bladders were catheter-free. In those with acontractile bladders, 15/19 (78.9%) demonstrated significant return of detrusor function on 6-month UDS. TURP and PVP have also shown benefit in relieving urinary retention in men with BPH and impaired detrusor contractility, but typically with lower rates of catheter-free patients compared to HoLEP.459-461 Patient comorbidities should be considered prior to proceeding with resective therapy. It should be noted that patients with known neurological conditions that can affect bladder function should be evaluated in accordance with the AUA/SUFU Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Guideline and should not be offered resective procedures except in select situations after appropriate counseling.70 Additionally, patients with other known medical comorbidities that are prohibitive to procedural therapies should not be offered resective technologies.