Background: Benign prostatic hyperplasia (BPH), the most common benign neoplasm in men. Despite the development of medical therapy and alternative minimally invasive procedures, the monopolar transurethral resection of the prostate still    the “gold standard" in the operative management of BPH . Purpose:  To evaluate  efficacy and safety of suprapubic cystostomy  during resection of the prostate  > 80 gram. Patients and methods:  In this study patients operated with monopolar TURP between January 2018 and January 2019 were evaluated at zagazig university hospital  . During surgery a catheter (12 Fr) was placed suprapubically. All patients were followed-up for at least 6 months  after surgery. Results: the mean  age (64.95±4.43), IPSS (28.81±2.08), , and post void residual (PVR) 82.75±20.9. Mean prostate volume was (88.87±7.5)g . mean surgical  time was (47.5±7.03 )/min , mean catheter time removed was( 2.37±0.44) day, mean  post  operative  hospital stay was (2.38±0.46)day, mean  bladder pressure was (11.83 ±0.44) cmH2, mean percentage of resection to prostate size(0.60±0.08) and the mean  Resection efficiency was (1.14±0.23)g /mint. Blood transfusion was not necessary and developed TUR syndrome (0.0). At follow-up the mean IPSS (3.55±1.), and PVR (18.79±7.27). regard late complication (16cases) 66.7% were without any complication  29.2% with retrograde ejaculation and 1 case 4.2% was with incontinence. Conclusion: we can conclude the using of suprapubic cystostomy during monopolar transurethral resection of large prostate > 80 gram, is  more safe and more effective method .