Purpose <p>Urge urinary incontinence (UUI) frequently coexists with bladder outlet obstruction (BOO) in men with benign prostatic hyperplasia (BPH), yet its postoperative course following thulium laser enucleation of the prostate (ThuLEP) remains insufficiently characterized. This study evaluated symptom recovery at 3 and 12 months after ThuLEP and identified factors associated with postoperative UUI at 3 months.</p> Materials and methods <p>We performed a retrospective analysis of a prospectively maintained single-center database including 629 men who underwent ThuLEP between January 2021 and December 2024. UUI was defined as Overactive Bladder Symptom Score item 4 ≥ 1 combined with International Consultation on Incontinence Questionnaire–Short Form ≥ 1, excluding stress-predominant leakage. Symptom assessments were conducted at baseline, 3 months, and 12 months. Multivariable logistic regression identified factors associated with postoperative UUI at 3 months.</p> Results <p>Preoperative UUI was present in 217 patients (34.49%). These patients exhibited significantly greater storage symptom burden but similar prostate volume and intravesical prostatic protrusion. At 3 months, both groups showed marked improvement in voiding function and overall symptom scores; however, postoperative UUI remained more frequent in those with preoperative UUI. By 12 months, overall LUTS severity was comparable between groups, with only mild residual differences in OABSS-4. Among patients with preoperative UUI, baseline OABSS, ICIQ-SF, and maximum urinary flow rate were independently associated with postoperative UUI at 3 months.</p> Conclusions <p>Preoperative UUI is common among men undergoing ThuLEP and is associated with greater storage symptom burden. Although early postoperative UUI is more frequent in these patients, both voiding and storage symptoms improve substantially and remain relatively stable over time.</p>