INTRODUCTION Monopolar transurethral resection (M-TUR) is a standard for comparing various endoscopic techniques for benign prostatic hyperplasia (BPH), including extraperitoneoscopic adenomectomy (EA). AIM To compare the effectiveness and safety of M-TUR and EA in the surgical management of BPH with a prostate volume of 100-180 cm3. MATERIALS AND METHODS Medical records of 797 patients, who underwent surgery for BPH from 2011 to 2016, were retrospectively evaluated. The study comprised patients with a prostate volume of 100-180 cm3, who received either EA (group 1, n=34) or M-TUR (group 2, n=24). RESULTS The groups did not statistically significantly differ in age (69.3+/-6.9 vs 71.4+/-6.4 years in group and 2, p=0.328); complication rate (4 (11.7%) and 6 (25%), respectively, p=0.31); increase in the maximum urinary flow (10 ml/ s (Q1-Q3: 10.0-10.5), 13.5 ml/s (Q1-Q3: 7.5-17), respectively, p=0.538); postoperative hospital stay (11 (Q1-Q3: 10-14) and 10.5 (Q1-Q3: 8-17), respectively, p=0.875). There was statistically significant difference in operative time (190 and 82.5 min in the 1st and 2nd groups, respectively, p=0.041), and in blood loss (200 ml (Q1-Q3: 150-300) and 400 ml (Q1-Q3: 400-500), respectively, p=0.008). During 12 month follow-up, only 5 (20.8%) patients in the 2nd group (p=0.012) needed repeat surgery. Urinary incontinence of different severity at the time of discharge from hospital was also observed only in 4 (16.6%) patients the 2nd group (p=0.036). CONCLUSION EA and M-TUR have similar safety and effectiveness in the surgical management of patients with BPH with the prostate volume of 100-180 cm3. EA is associated with longer operative time than M-TUR, but is accompanied by less blood loss, does not require repeat surgery, and confers less risk for urinary incontinence.