Prostate enlargement is a common disease in older men, and with the aging of society, there is an increasing number of high-risk prostate enlargement patients of advanced age. High-risk prostatic hyperplasia patients refer to several of these disorders combined with chronic bronchitis, emphysema, pulmonary heart disease, hypertension, coronary artery disease, diabetes, and post-stroke sequelae. They are characterized by comorbidities, many surgical complications and high surgical risks. In the past, these patients were mainly treated conservatively with drugs, and when urinary retention occurred, indwelling catheterization or suprapubic cystostomy was performed, which caused inconvenience and seriously affected patients’ quality of life due to the need to replace the fistula tube for a long time, and was prone to infection and fistula tube slippage. With the maturation of minimally invasive surgery, the treatment of these patients has become possible. Recently, about 80% of patients with prostatic hyperplasia admitted to our urology department belong to this category, and all of them have achieved satisfactory results after treatment. The surgery is poorly tolerated by elderly and high-risk BPH patients. Pre-operative understanding of the functional status of the heart, brain, liver and kidneys, active treatment of complications, medical cooperation to improve the general condition, control comorbidities, so that the heart and lung function in a relatively stable state, significantly improve the tolerance of surgery. The use of transurethral prostate plasma electrosurgery shortens the operation time, completely stops bleeding, reduces intraoperative bleeding, water toxicity and other complications, closely observes changes in vital signs after surgery, correctly manages comorbidities, prevents complications in a timely manner, and ensures that elderly and high-risk BPH patients safely pass the perioperative period. The prostate enlargement surgery in our urology department has become a feature of the treatment of prostate enlargement disease in our hospital, with no serious postoperative complications in any patient and significant improvement in postoperative urination, which is safe and effective.