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OBJECTIVES We compared the safety and efficacy of transvesical prostatectomy(TVP)and transurethral resection of the prostate(TURP)for prostate greater than 80 mL in a prospective randomized trial.METHODS Eighty patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and assigned to TVP or TURP.Patients were assessed preoperatively and followed up at 3 and 12 months postoperatively.Intetnational prostate symptom score(IPSS),quality of life score(QoLS),maximum flow rate(Q(max)(.)),and postvoid residual volume(PVR)were obtained at each follow-up.Perioperative data and postoperative outcomes were compared.All complications were recorded.RESULTS Of 80 patients eligible to participate,69 patients completed 12 months of follow-up.TURP procedure was not faster than TVP procedure(P =.41); 53.2% and 84.4% of prostatic tissue were resected after TURP and TVP,respectively(P <.001).In the TVP group,IPSS,Q(max)(.),QoLS,and PVR volume were significantly better than those in TURP group at 3 and 12 months of follow-up.At 12 months postoperatively,IPSS improved 87.6% and 62.3%,mean Q(max)(.)increased by 11.49 mL/s(230.2%)and 6.33 mL/s(102%),and mean PVR volume decreased by 71.2 mL(88.6%)and 65.4 mL(70.5%)in TVP and TURP group,respectively.Two TURP patients developed urethral stricture requiring reoperation.CONCLUSIONS TVP may be more effective and safer than TURP for the benign prostatic hyperplasia patient whose prostate volume is >80 mL.