BPH involves hyperplasia of both glandular and stromal elements in the prostate transition zone, driven by DHT-mediated androgen receptor signaling. DHT activates paracrine stromal-epithelial interactions promoting cell proliferation, reduced apoptosis, extracellular matrix remodeling, and glandular enlargement. Growth factors (FGF, KGF, IGF-1) favor proliferation while TGF-beta provides antiproliferative signals; the balance determines disease progression. Bladder outlet obstruction produces both voiding symptoms (from increased urethral resistance) and storage symptoms (from detrusor instability and increased residual volumes). Alpha-1 adrenergic receptor-mediated smooth muscle tone contributes dynamic obstruction, explaining the rapid benefit of alpha-blockers. TURP removes obstructing prostatic tissue via resectoscope using monopolar or bipolar electrocautery. The nurse manages pre- and post-operative care, continuous bladder irrigation, hemorrhage prevention, and early detection of TURP syndrome (dilutional hyponatremia from hypotonic irrigation fluid absorption). Bipolar TURP using normal saline irrigation has significantly reduced TURP syndrome incidence.