Objective To investigate the clinical effect and safety of transurethral columnar balloon dilation of prostate(TUDP) in the treatment of benign prostatic hyperplasia (BPH) in high risk elderly patients. Methods Totally 100 elderly patients with high-risk BPH undergoing elective surgical treatment in our hospital from January 2015 to October 2016 were enrolled in this study. They were randomly divided into bipolar plasmakinetic transurethral resection of prostate (BP-TURP)and TUDP group (50 cases for each group). The clinical efficacy and safety were observed and compared between the 2 groups. Results Compared with the BP-TURP group, the TUDP group had significantly less amount of intraoperative bleeding,and obviously shorter operation time, catheter retention time and postoperative hospital stay length (P<0.05). There were no significant differences in international prostate symptom score (IPSS), residual urine volume (RUV), quality of life scale (QOL) and maximum urinary flow rate (Qmax) between the 2 groups before and in 3 months after treatment (P>0.05). No significant differences were seen in the incidences of complications, such as hematuria, urethral stricture, and temporary urinary incontinence between the 2 groups (P>0.05). Conclusion TUDP has the advantages of small incision and quick recovery, and is a good option for high risk elderly BPH patients.