169 Archivio Italiano di Urologia e Andrologia 2022; 94, 2 ORIGINAL PAPER No conflict of interest declared. refractory LUTS, and transurethral resection of the prostate (TURP) is the procedure of choice for the majority of men with BPH/LUTS, especially for prostate volumes between 30 and 80 mL (1). Despite all the technological and technical improvements since the initial TURP descriptions almost a century ago (3), there is still controversy regarding the need for a complete prostatic tissue resection. Although some litera- ture recommends a total removal of the adenomatous tis- sue (4), a relevant body of research supports the thesis that a complete adenoma resection may not be essential, with similar post-operative results with or without it (6). Similarly, a relationship between the amount of resected prostate and the outcomes of the surgery has been pur- sued, yet no correlation has been found between these two variables, neither in smaller (< 40 g) nor in larger (> 40 g) prostates (6). TURP is especially effective when bladder outlet obstruction (BOO) due to Benign Prostatic Obstruction (BPO) is the main cause for the patient’s LUTS. A satisfactory surrogate marker for the severity of BOO may however be obtained with urinary flow rate studies, as stated by the Siroky- Liverpool nomograms, in which maximum flow rate (Q max ) and bladder volume are used to predict BOO (7). Furthermore, a recent randomized controlled trial was not able to prove a benefit in performing urodynamic studies in men with LUTS, since surgical treatment was necessary in around 37% of patients irrespectively of per- forming urodynamic studies (8). Although considered a safe procedure, sexual side effects after TURP are still an important issue, with 60-70% of patients reporting retrograde ejaculation, and up to 6.5% complaining of erectile dysfunction (9). Other side effects include early urge-incontinence, even though late stress incontinence is rare (0.5%) (10). In recent years, new approaches to TURP have been developed, aiming at the reduction of morbidity while maintaining the benefits of the procedure. In that regard, ejaculation preserving tech- niques are a promising development, with reports of ante- grade ejaculation at 3 months post-op in around 90% of patients undergoing ejaculation preserving TURP (epTURP), with symptomatic and functional outcomes similar to the classic technique (11, 12). A vaporization technique using laser (LEST) has also been described, with antegrade ejaculation maintained in up to 80% of Objectives: Transurethral resection of the prostate (TURP) remains one of the gold- standard surgical treatments for benign prostatic hyperplasia/lower urinary tract symptoms. The usefulness of a complete adenoma resection is questionable, with studies report- ing no impact of the amount of resected tissue on surgical out- comes, irrespective of prostate volume. The aim of this study was to assess whether in less obstructed patients a less extensive TURP may be considered. Materials and methods: Retrospective analysis of 185 men undergoing TURP in one university hospital. Retrieved data included pre-operative prostate volume and Q max , as well as resected prostate weight and post-operative Q max . Patients were divided in two groups according to pre-operative Q max < 10mL/s and ≥ 10 mL/s. Results: A correlation was found between absolute resected prostate weight and post-operative Q max in the group of patients with pre-operative Q max < 10 mL/s (r 2 = 0.038, p = 0.032), inde- pendently of the pre-operative prostate volume. This association was neither observed in the group of patients with pre-operative Q max ≥ 10 mL/s (r 2 = -0.033, p = 0.796) nor in whole population analysis (r 2 = 0.019, p = 0.064). Likewise, in the group of patients with pre-operative Q max < 10 mL/s, the improvement in Q max was correlated with absolute resected weight and percent- age of prostate resected weight (r 2 = 0.036, p = 0.037 and r 2 = 0.040, p = 0.029, respectively). None of these correlations was found in the group of patients with pre-operative Q max ≥ 10 mL/s (r 2 = 0.009, p = 0.463 and r 2 = -0.018, p = 0.294, respec- tively). Conclusions: Patients with pre-operative Q max ≥ 10 mL/s may do well with less profound prostate resections, whereas patients with lower pre-operative Q max seem to benefit from a complete adenoma resection. KEY WORDS: Transurethral resection of prostate; Prostatic hyperplasia; Lower urinary tract symptoms; Adenoma; Urologic surgical procedures. Submitted 12 May 2022; Accepted 27 May 2022 INTRODUCTION Benign prostatic hyperplasia (BPH) is one of the most com- mon causes of lower urinary tract symptoms (LUTS) in men. Current international guidelines recommend a step- wise approach to the treatment of BPH/LUTS (1). However, surgery remains the gold-standard in severe or Prostate resection weight matters in severely obstructed men undergoing transurethral resection of the prostate Filipe Lopes 1 , Ricardo Pereira e Silva 1, 2 , Miguel Fernandes 1 , Tito Palmela Leitão 1, 2 , José Palma dos Reis 1, 2 1 Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; 2 Urology University Clinic, Faculty of Medicine, University of Lisbon, Portugal. DOI: 10.4081/aiua.2022.2.169 Summary