BPH is a progressive disease and some patients eventually require surgical treatment to relieve lower urinary tract symptoms and their impact on quality of life and complications. 1. Indications for surgical treatment Patients with moderate/severe BPH whose lower urinary tract symptoms have significantly affected the patient’s quality of life may opt for surgical treatment, especially if medication is not effective or if they refuse to receive medication. Surgical treatment is recommended when BPH patients present with the following complications: recurrent urinary retention (inability to urinate after at least one extubation or twice) recurrent hematuria, ineffective treatment with 5-alpha reductase inhibitors recurrent urinary tract infections bladder stones secondary upper urinary tract fluid (with or without renal impairment) BPH patients with combined large bladder diverticula, inguinal hernia, severe hemorrhoids or prolapse, clinical judgment not Surgical treatment should be considered for those who have difficulty achieving therapeutic results without relieving lower urinary tract obstruction. Measurement of residual urine volume and maximum urinary flow rate has some reference value for the degree of lower urinary tract obstruction due to BPH, but it is not currently considered to be an indication for surgical treatment alone because of the instability of repeated measurements, interindividual variability, and the inability to distinguish lower urinary tract obstruction from bladder contractile weakness. The physician’s choice of treatment modality will respect the patient’s wishes. The choice of surgical modality should take into account the physician’s treatment experience, the patient’s opinion, the size of the prostate, and the patient’s concomitant disease and general condition. The effect of BPH treatment is mainly reflected in the change of the patient’s subjective symptoms (e.g. I-PSS score) and objective indicators (e.g. maximum urinary flow rate). The evaluation of treatment methods should take into account the treatment effect, complications and socio-economic conditions and other comprehensive factors. (1) Conventional surgery The standard surgical treatment options are transurethral resection of the prostate (TURP), transurethral resection of the prostate (TUIP) and open prostate removal. TURP is still the best way to treat BPH. Various surgical approaches have treatment outcomes close to or similar to TURP, but differ in their scope of application and complications. As an alternative to TURP or TUIP, transurethral electrical vaporization of the prostate (TUVP) or plasma bipolar electrosurgery (PKVP) is now also used for surgical treatment. All of the above treatments are able to improve more than 70% of the lower urinary tract symptoms in patients with BPH. ①TURP is mainly used to treat BPH patients with prostate volume below 80 ml, and the limit of prostate volume is relaxed appropriately according to the technical proficiency of the surgeon. The incidence of blood volume expansion and dilutional hyponatremia (transurethral resection syndrome) due to excessive absorption of flushing fluid is about 2%. Risk factors for transurethral resection syndrome include high intraoperative bleeding, long operative time, and large prostate volume. the risk of transurethral resection syndrome increases significantly with longer TURP procedures. The chance of needing blood transfusion is about 2-5%. The incidence of various post-operative comorbidities: urinary incontinence 1-2.2%, retrograde ejaculation 65-70%, bladder neck contracture about 4%, urethral stricture about 3.8%. ② TUIP is indicated for patients with prostate volume less than 30 ml and without middle lobe hyperplasia. the degree of improvement of patients’ lower urinary tract symptoms after TUIP treatment is similar to that of TURP. Compared to TURP, there are fewer complications, lower risk of bleeding and need for blood transfusion, lower incidence of retrograde ejaculation, shorter operative time and hospital stay. However, the long-term recurrence rate is higher than that of TURP. The main application is for patients with prostate volume greater than 80ml, especially those with combined bladder stones or bladder diverticula that need to be operated together. The common procedures are suprapubic prostatectomy and retropubic prostatectomy. The incidence of postoperative comorbidities is higher than that of TURP: about 1% for urinary incontinence, 80% for retrograde ejaculation, 1.8% for bladder neck contracture, and 2.6% for urethral stricture. ④TUVP is indicated for patients with BPH who have poor coagulation and a small prostate volume. It is an alternative to TUIP or TURP. The long-term complications are similar to those of TURP. ⑤ PKVP uses a bipolar plasma electrodesection system to perform transurethral resection of the prostate in a similar manner to monopolar electrodesection. The incidence of intraoperative bleeding and transurethral electrodesiccation syndrome is reduced due to the use of saline as the intraoperative irrigation fluid.