<prompt> Grade I benign prostate with outflow obstruction is best treated with -Retropubic prostatectomyTransurethral resectionTransvesical prostatectomyAndrogen therapy  <response>: MC indication for surgery is symptoms interfering with quality of life bothersome symptoms and symptoms of BOO. TURP Gold standard : Cystoscopic removal of strips of prostatic tissue using diathermy loop. Two techniques; NESBIT technique preferred maver mayer technique Best irrigant fluid is 1.5 glycine Electrolyte solutions like NaCl are not compatible with electrocautery, so not used. Glycine is composed of glycolic acid and ammonium, which can cause CNS visual toxicity.TURIS: TUR in saline using bipolar cautery Verumontanum is the single most important anatomical landmark in TURP. Verumontanum lies immediately proximal to external sphincter and serve as the distal landmark for prostate resection to prevent injury to the external sphincter. Verumontanum: Distal landmark for prostate resection. Verumontanum: Landmark for proximal limit of external sphincter. Risks of TURP: Retrograde ejaculation 75Q, impotence 510 and incontinence 1. Complications: Bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and if severe, TUR syndrome.TUR syndrome Dilutional hyponatremia or water intoxication TUR syndrome Dilutional hyponatremia or water intoxication resulting from a hypervolemic, hyponatremic state due to absorption of the hypotonic irrigating solution. Clinical Features: Nausea, vomiting, confusion, hypertension, bradycardia, and visual disturbances. The risk increases with resection times 90 minutes or gland size 75 gm. Treatment includes diuresis furosemide and in severe cases, hypertonic saline 3 administration.Late Complications of TURP Bladder neck stenosis 4 Urethral stricture 3.6 Bladder neck stenosis is seen more often with small 30 gm fibrotic prostates. Transurethral incision of the prostate TUIP: For posterior commissure hyperplasia elevated bladder neck, involves two incisions using the Collins knife at the 5- and 7-oclock positions. The incisions are started just distal to the ureteral orifices and are extended outward to the verumontanum. TUIP lowers the incidence of bladder neck contracture when compared to TURP, so TUIP should be strongly considered in patients with smaller gland in place of TURP. TUIP is used for smaller 20 gm prostate, young patients. Decreased incidence of retrograde ejaculation as compared to TURP. Open simple prostatectomy: Glands 75 gm, concomitant bladder diverticulum or a bladder stone or if dorsal lithotomy positioning is not possible. Suprapubic prostatectomy: Performed transvesically Frayers and operation of choice in dealing with concomitant bladder pathology Bladder stones or diverticulum. Retropubic prostatectomy Millins: Transverse incision is made in surgical capsule of prostate and enucleation is done. Perineal prostatectomy Youngs: Abandoned now Carcinoma prostate originates in peripheral zone of prostate, so prostatectomy for BPH confers no protection for subsequent cancer. 