OBJECTIVE To compare the safety and efficiency of plasmakinetic enucleation of the prostate (PKEP) with that of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Three hundred ten patients diagnosed to have BPH were randomized to undergo either PKEP or PKRP. The perioperative data and postoperative outcomes followed at 1, 3, 6, 12, 18, and 24 months after surgery were recorded and compared in the groups classified according to the baseline prostate volume: <= 60 mL and >60 mL. RESULTS There were no significant differences in the preoperative data. Compared with PKRP, PKEP costs longer operative time (56.1 +/- 14.6 vs 41.3 +/- 9.6 min; P <.001) for prostate volume <= 60 mL, but reduced operative time (75.6 +/- 12.3 vs 88.7 +/- 14.3 minutes; P <.001) and caused less blood loss (167.6 +/- 44.4 vs 225.7 +/- 49.5 mL; P <.001) for prostate volume >60 mL. However, regardless of prostate size, the incidence of transient incontinence after PKEP was higher. The postoperative improvement among these groups in International Prostate Symptom Score, quality of life, and maximal flow rate was similar at 24-month follow-up. CONCLUSION PKEP and PKRP are both safe and effective treatments for BPH independent of prostate size. Despite that the incidence of transient incontinence after PKEP was higher, PKEP was significantly superior to PKRP in operative time and blood loss for prostate volume >60 mL and may become the modern alternative to PKRP for large BPH. (C) 2014 Elsevier Inc.