BACKGROUND Previous reports have suggested an inverse relationship between smoking and surgery for benign prostatic hyperplasia (BPH). We hypothesized that acute urinary retention (AUR), an adverse outcome of this disease and indication for surgical treatment, may be related to smoking. METHODS Study subjects were randomly selected from Olmsted County men aged 40–79 identified through the Rochester Epidemiology Project. Of the 3,854 eligible men, 2,089 (54%) completed a questionnaire that included the American Urological Association Symptom Score and assessed smoking status. Community medical records were examined for occurrence of AUR with documented catheterization in the subsequent 10 years and occurrence of BPH surgery. Proportional hazard models were used to assess the relationship between baseline smoking status and subsequent retention. RESULTS In the 18,307 person-years of follow-up, 114 men had AUR. When compared to 727 never-smokers, there was a trend among the 336 current smokers to be at lower risk (Relative risk (RR) = 0.62, 95% Confidence Interval (CI) = 0.33, 1.18) whereas the 1,026 former smokers were at similar risk to non-smokers (RR = 1.0, 95%CI = 0.67, 1.46). Among men with moderate-severe symptoms at baseline, current smokers were at lower risk of retention compared to non-smokers (RR = 0.65, 95%CI = 0.22, 1.91) but the association approached the null among those with none-mild symptoms (RR = 0.91, 95% CI = 0.40, 2.06). CONCLUSIONS Community-dwelling men who currently smoke may be at a modestly reduced risk of AUR. The magnitude of this association is sufficiently small that it seems unlikely that this explains a sizable proportion of the inverse association between smoking and surgically treated BPH. Prostate 69: 699–705, 2009. © 2009 Wiley-Liss, Inc.