A prospective study of 50 cases of BPH treated by medical and surgical therapy was done. Aim of the study was to compare the efficacy of medical verses surgical management. Transurethral resection of prostate was done in 15 patients while rest were managed by medical treatment. Significant symptomatic improvement was noted in surgical management group compared with other. No difference was noted in patients managed with medical monotherapy or combined therapy. There was significant reduction in residual urine and increase in urine flow rate in surgical management group verses medical. Conclusion: Surgical management of BPH has superior results with TURP being gold standard procedure. Medical therapy should be offered to patients not willing or unfit for surgery or having early symptoms. Medical monotherapy with alfa–1–antagonist was effective in improving urinary symptoms and urinary flow rates in BPH patients and addition of 5–alfa–reductase inhibiters did not provide further benefit.