OBJECTIVE To investigate the perioperative parameters and postoperative sexual function and complications in native Tibetans undergoing transurethral resection of the prostate (TURP) for BPH with different prostate volumes. METHODS From June 2015 to February 2017, 325 native Tibetans with BPH underwent TURP in the People's Hospital of Tibet Autonomous Region. The patients were aged 59－88 years, with a median oxygen saturation level of 84% in the normal status, 24% with hydronephrosis, 40.3% with the history of acute urinary retention, 61.8% with pulmonary hypertension, and 19.1% taking regular medication preoperatively. According to the preoperative prostate volume (PV), the patients were divided into a large PV (LPV) group (PV ≥80 ml, n = 124) and a small PV (SPV) group (<80 ml, n = 201). Perioperative parameters and postoperative sexual function and complications were analyzed and compared between the two groups of patients. RESULTS The operation time was significantly longer in the LPV than in the SPV group (［92.36 ± 26.35］ vs ［56.28 ± 24.61］ min, P < 0.05) and the intraoperative blood loss was higher in the former than in the latter (［401.12 ± 50.12］ vs ［385.15 ± 51.62］ ml, P < 0.05). Compared with the baseline, at 6 months after operation, the IPSS was significantly decreased in all the patients (22.13 ± 6.23 vs 5.29 ± 1.14 in the LPV group, P < 0.05; 23.04 ± 6.82 vs 5.12 ± 1.28 in the SPV group, P < 0.05), and the maximum urinary flow rate (Qmax) remarkably improved (［17.46 ± 5.82］ vs ［5.91 ± 1.86］ ml/s in the LPV group, P < 0.05; ［17.99 ± 5.86］ vs ［6.01 ± 1.92］ ml/s in the SPV group, P < 0.05). The incidence rate of retrograde ejaculation was markedly higher in the LPV than in the SPV group postoperatively (48.4% vs 20.9%, P < 0.05). No statistically significant differences were observed between the two groups of patients in the incidence of postoperative complications (13.71% vs 9.45%, P > 0.05). CONCLUSIONS TURP is effective and safe for the treatment of BPH native Tibetans with different prostate volumes.