## 3 Results  
A total of 66 patients were enrolled. Preoperative characteristics are listed in Table 1.  
The mean patient age was 69.1 years (range 55-82). About one-third (32%) of the patients had a history of at least one episode of urinary retention prior to surgery. The prostate volume was higher than 60 mL in 76.7% of patients, with a mean prostate volume of 91 mL (range 40-202). The mean values of Qmax and PVR were 10.3 mL/s (range 4-14) and 80 mL (range 0-250), respectively. Preoperatively, the IPSS and International Index of Erectile Function 5-item (IIEF-5) assessment resulted in values of 19.3 (range 4-31) and 16.3 (range 2-25), respectively. The mean preoperative PSA was 4.9 ng/mL (range 0.31-22). Intra- and peri-operative data are shown in Table 2.  
In our series, the median OT was 122 min (range 95-153), the median DaE was 138 kJ, (range 105-165), and the median \(\Delta\)Hb was 0.8 gr/dL (range (0.3-2.1)). The median percentage of enucleated tissue was 61% (range 42-70%). The catheterization time and LOS were 32 h (range 24-55) and 48 h (range 24-86), respectively. The mean postoperative PSA value was 0.77 ng/mL (range 0.05-2.91). The detection rate of iPCa was 3%: one patient was diagnosed with an adenocarcinoma Gleason score (GS) of 3+3 pT1a, while in another case, a stromal tumor of uncertain malignant potential (STUMP) was incidentally found. In both cases, a conservative watchful waiting strategy was carried out. The overall complication rate was 7/66 (10.5%). A small bladder perforation (grade 1 EAUia \begin{table}
\begin{tabular}{c c} \hline \hline
**Characteristic** & **Value** \\ \hline Mean age, years (range) & 69.1 (60–78) \\ Previous alpha-blockers, \(n\) (\%) & 63 (95\%) \\ History of urinary retention, \(n\) (\%) & 21 (32\%) \\ Mean serum PSA, ng/mL (range) & 4.28 (2.5–6.39) \\ Mean prostate volume, mL (range) & 86 (61–110) \\ Mean Qmax, mL/s (range) & 10.7 (7–14) \\ Mean PVR, mL (range) & 65 (30–100) \\ IPSS, points (range) & 21 (12.5–24.5) \\ IIEF-5 (range 4–31) & 16.3 (2–25) \\ \hline \hline \end{tabular} PSA: prostate-specific antigen; Qmax: maximum flow rate; PVR: post-void residual; IIEF-5: 5-item version of the International Index of Erectile Function.  
\end{table} 
Table 1: Patients’ characteristics. Figure 6: Final result: endoscopic view. morellator phase, which was treated by an indwelling bladder catheter for four days. No conversion to TURP or OSP occurred. One (1.5%) intra-operative complication, a bladder perforation during the morellation time, occurred. Postoperative complications (Table 3) were 6/66 (9%), and all were of grade II according to the Clavien-Dindo classification: one patient (1.5%) developed thrombobbleitis of the lower extremity, which was treated with cortisone and heparin therapy; two patients (3%) were recthetized for acute urinary retention and were discharged with a Foley catheter, which was removed after 4 days; and one patient (1.5%) experienced urethral stricture, thus needing urethro-cytoscopy with concomitant urethral dilatation. Two patients (3%) reported UTI in the postoperative period; they were successfully treated by adequate antibiotic therapy. At a median follow-up of 15 months (range 1-24), there were no cases of reoperation or sclerosis of the bladder neck/prostatic loggia. Concerning the functional outcomes (Table 4), the mean Qmax and PVR at 1 month were 28 mL/s (range 7-63) and 12 mL (range 0-100), respectively, with subsequent further improvements at 6 months with mean values of 35 mL/s (range 15-68) and 5 mL (range 0-38), respectively. At 1, 3, and 6 months, the IPSS and the IEF-5 were 11.4 (range 2-25) and 13.8 (range 0-25), 4.3 (range 2-11) and 16.1 (range 0-25), and 2.7 (range 0-16) and 15.3 (range 0-25), respectively. At the first postoperative month, 23/66 (34.8%) of the patients were affected by UI, narrowly 16.7% by UUI, 13.6% by stress urinary incontinence (SUI), and 4.5% by mixed urinary incontinence (MUI).