OBJECTIVES: To evaluate the costs and outcomes of two Benign Prostatic Hyperplasia (BPH) surgical procedures available in the public healthcare system in Brazil. METHODS: A 3-year longitudinal analysis (2009 to 2011) of an anonymized government administrative database (Inpatient Information System - SIH/DATASUS) was performed. The study cohort comprised all BPH hospitalization registries (ICD10 D299 and N40) from male patients and aged 40 years and over.  Patients were uniquely identified by the following parameters: date of birth, postal code, gender and ethnicity. Deterministic registry matching was applied. Costs were reported in 2012 Brazilian currency (1BRL=0.52USD). Outcomes assessed were reoperation rates, average in-hospital length-of-stay (in days), and need for intensive care unit (ICU). Descriptive statistics [i.e., average, standard deviation (SD) and proportions] summarized studied data. RESULTS: A total of 48,750 patients with average age of 68.3±8.6 were identified within 3 years of analysis. 21,747 patients were submitted to SP (total cost BRL27.9 million) and 27,003 to TURP (total cost BRL22.0 million). There were different proportions of surgical types among Brazilian regions, SP and TURP, respectively: North (N) 69.5% vs. 30.5%, Northeast (NE) 57.7% vs. 42.3%, Central West (CE) 43.3% vs. 58.7%, South (S) 41.3% vs. 58.7% and Southeast (SE) 32.6% vs. 67.4%. SP was linked with longer in-hospital length-of-stay (6.45±5.29) versus TURP (3.95±4.31) and also with an increased proportion of procedures requiring ICU 4.2% and 2.6%.  The rate of reoperation was 0.5% in SP and 1.8% in TURP patients. CONCLUSIONS: SP compared with TURP procedure was linked with more costs to public healthcare system in Brazil, a higher need for ICU utilization and increased days of hospitalization. Nevertheless, reoperation rates following SP were lower than TURP. A higher number of SP procedures in different Brazilian regions may be related to availability/access/discrepancies in the treatment of BPH, lack of technology and under diagnose.