Actually: Benign prostatic hyperplasia occupies a leading place among all urological diseases in older men. Moreover, its significance is determined not only by its high prevalence, but also by the frequent development of complications due to impaired outflow of urine from the bladder. Severe bladder outlet obstruction is an indication for surgical treatment of BPH. The aim to identify the optimal method of surgical treatment of prostatic hyperplasia in persons of the older age group with mild to moderate senile asthenia. Materials and methods. The study included 152 patients undergoing treatment at St. Petersburg State Budgetary Healthcare Institution City Hospital 15, in the period from November 2019 to December 2020, for BPH with severe dysuria. The volume of the prostate ranged from 80 to 125 cm3, with 91 people from 80 to 100 cm3, and 61 people from 101 to 125 cm3. The control examination after the operation was carried out on the 5-7th day, 3 and 6 months after the operation. Results. The patients were divided into 4 study groups. The first group of patients underwent bipolar transurethral resection of the prostate (n = 38), the second - bipolar plasma-kinetic enucleation (n = 47), the third - thulium laser enucleation of the prostate gland (n = 51), the fourth - laparoscopic inter-vesicular adenomectomy (n = 16). We assessed intraoperative parameters, such as: duration of surgery, duration of postoperative irrigation, catheterization of the bladder, bed-day spent in the hospital. In the late postoperative period, after 3 and 6 months, patients were invited to conduct a control study, which included: urodynamic study, assessment of residual urine volume, IPSS, control filling of gerontological questionnaires. In comparison with the initial values, there was a significant increase in indicators characterizing the improvement in the quality of life of patients, in particular, from a moderate degree of senile asthenia, most patients were classified as patients with a mild degree. Conclusion. Active surgical tactics, in the absence of contraindications, allows restoring urination, which in turn improves both the patient's quality of life and reduces the degree of senile asthenia, regardless of the type of operation. However, when assessing both early and late postoperative parameters, body laser enucleation is superior to all other methods in terms of the safety and effectiveness of BPH surgery in age-related comorbid patients this is primarily reflected in the relatively short duration of the operation, the radical nature of the method, a decrease in the duration of hospitalization, early rehabilitation of patients, as well as high efficiency in the late postoperative period. Analyzing the data after 3 and 6 months, this technique showed the best functional results.