Abstract: Objective To compare the clinical effects and safety between greenlight photoselective vaporization of prostate (PVP） and plasmakinetic resection of prostate （PRP） in eldly benign prostatic hyperplasia (BPH) men with high surgical risk. Methods Fifty three eldly BPH patients, who had the indication of surgical treatment but complicated with at least one internal disease, were randomly divided into PVP group and PRP group. The clinical data of all the patients were collected and compared between the two groups,including pre-operative and post-operative international prostate symptom score (IPSS), postvoid residual urine (PVR), urine flow rate (Qmax), quality of life (QOL) as well as prostate volume (PV), operational time, operative bleeding volume, post-operative recovery, peri-operative complications. Results The complete follow-up data of 44 patients were achieved: 21 of PVP, 23 of PRP. There were significant differences between two groups in operative bleeding、bladder irrigation time、indwelling catheter time and hospital stay (P<0.002). The peri-operative bleeding was lower in PVP group, while the bladder irrigation time、indwelling catheter time and hospital stay were shorter in PVP group. The operation time showed no difference (P=0.12). No significant differences were found 3 months postoperatively between two groups in all the data associated with urination (IPSS, Qmax,PVR, QOL) , P>0.05. Complications (urethrostenosis, retrograde ejaculationwere acceptable in both groups. Conclusion For surgical treatment of eldly men with high surgical risk, both PVP and PRP are safe and effective with the internal disease being sufficient control.