Background: Benign prostatic hyperplasia (BPH) is a hyperplastic process of the glandular epithelial elements and fibromuscular stromal elements of the prostate. Objectives: evaluate the safety and efficacy of Holmium laser bladder neck incision for management of Bladder outlet obstruction (BOO) due to BPH less than 30 grams in patients with and without antithrombotic therapy. Patients & Methods: the current study included a total of 36 patients who admitted with symptomatic benign prostatic hyperplasia; 24 of them with antithrombotic and 10 patients without antithrombotic drugs to Department of Urology, Faculty of Medicine; Zagazig University Hospitals, during the period from January 2018 to November 2018. All patients were assessed as requiring surgical treatment for BOO due to BPH with: prostate size ≤ 30 cc, PVR ≤ 300 mL, IPS score ≥ 8, Qmax ≤ 15 mL/sec. Results: Our study confirmed the safety and efficacy of holmium laser bladder neck incision technique for management of small prostate (< 30g) patients without antithrombotic therapy. Conclusions: Ho BNI procedure is efficient and safe in relieving BOO with prostate size < 30 cc in patients with and without antithrombotic therapy. The risk of postoperative hematuria and bleeding is less with Ho BNI because of its better haemostatic properties.