Background: Transurethral Resection of Prostate (TURP) is still the first option in treatment for these patients. The main adverse effects of TURP are bleeding and absorption of irrigation fluid. Objective: The main aim of the current study is to compare the efficacy of topical versus intravenous Tranexamic Acid (TXA) acid in decreasing blood loss in TURP. Patients and methods: This study was carried out over a period of 9 months on56 patients presenting with Lower Urinary Tract Symptoms (LUTS) secondary to senile enlarged prostate refractory to medical therapy and to TURP at Urology Department in Damietta Specialized and Suez Canal University Hospitals.Patients were divided into 2 groups; Group A received one gram of TXA intravenously at the beginning of the surgery, while the patients in the Group B received the drug in the irrigation fluid 500 mg/liter.Intraoperative blood loss was measured from the collecting bucket. Vital signs were observed for both groups preoperatively, during and after the surgery. Hemoglobin was determined preoperatively and postoperatively. Results: Our results found higher reduction in operative blood loss in Group A in comparison to Group B which was 147 and 215 ml, respectively.Moreover, we found that the mean operative time was highly significant different between both groups, longer in Group B (40 minutes) than in Group A (33 minutes).Our study results showed no difference regarding the hospital stay, capsular perforation, bleeding and clot retention. Conclusion: The use of TXA intravenously is better than its topical administration in decreasing the surgical blood loss during TURP.There is no evidence of reducing rate of post-operative complications between using TXA intravenously and topically TXA.