Introduction and objectives:  Benign prostatic hyperplasia (BPH) is the most common neoplasm affecting ageing male population worldwide. Introduction of combination medical  therapy has revolutionized in the management of symptomatic benign prostatic hyperplasia. It has been observed that the alpha blockers are relatively ineffective in patient with intravesical prostatic protrusion (IPP). This study is being design to evaluate whether there exist any difference of   vascular parameters  and histopathology between lateral lobe and IPP.  Methods: All  symptomatic BPH  patients attending the urology OPD from February 2015 to Oct. 2016 are included in this study who are refractory to medical management and those with complication of bladder outflow obstruction due to BPH with IPP. Patients were evaluated with doopler ultrasound and resected specimens were send separately for histopathological examination with the pathologist blinded regarding the nature and origin of specimen. Results: 28 patients qualified included in the study. Ultrasonographically estimated average prostatic volume of the patients in our study is 59.68 gm (SD 27.59) ranging from 26 –146 gm, mean invesical prostatic protrusion is 19.11 mm (SD  6.511) ranging from 9–34 mm comprising. Mean intraprostatic resistive index measured by color doppler  of lateral lobe is 0.7132 ( SD 0.139 and mean SE 0.026)  and Intravesical prostatic protrusion mean resistive index is 0.642 with SD 0.117  in our study patients. On T– test we observed  a statistically significant difference between resistive index of lateral lobe and intravesical prostatic protrusion (p value 0.045 , 95% CI 0.00156 – 0.13987) .  Histopathology  of 12 patients  showed  a difference with hyperplasia predominat of  stromal componant in intravesical prostatic protrusion (IPP).  In intravesical prostatic protrusion (IPP), stromal hyperplasia with or without chronic inflammatory cells more commonly seen  in 11  (39%) patients and in 1 (3%) patient  mainly chronic inflammatory  changes were observed whereas this finding was absent in lateral lobe specimens. On statistical analysis using Chi–Square test this difference is statistatically significant ( p value <5%). Conclusion: Some degree of cellular abnormality as well as alteration of intraprostatic vascular parameters were observed in our study. However it needs to be confirmed in randomized control study involving large number of population, having symptomatic benign prostatic hyperplasia with intravesical prostatic protrusion who failed medical therapy.