Objective To assess the safety and efficacy of transurethral plasmakinetic resection of prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH) in the aged patients at high risk. Methods Clinical data of 165 BPH patients at high risk with age of (73.3±5.6) years, ranging from 70 to 84 years, undergoing PKRP in our department from March 2009 to February 2013 were collected and retrospectively analyzed. The safety of PKRP was evaluated. All patients were followed up at least for 3 months. Parameters of urination were measured before PKRP and at 3 months after operation. Results The duration of procedure was (67±23)min ranging from 32 to 125min; the weight of resected prostate glands was (46.3±24.2)g, ranging from 16 to 86g; the blood loss was (85.0±23.1)ml, ranging from 50 to 154ml. There was no any case requiring blood transfusion; no transurethral resection syndrome or aggravation of original complication occurred during the operation and peri-operative period. All the 165 patients were followed up for 3 months at least, and no urinary incontinence was found after the operation. Compared with pre-operation, the peak flow rate was increased from (6.9±3.8) to (16.5±3.5)ml/s, while the international prostate symptom score (IPSS) was decreased from (21.6±5.8) to (7.3±4.2), the quality of life (QOL) from (4.6±0.8) to (1.2±0.9), and the residual urine volume (RUV) from (65.2±31.6) to (7.5±4.5)ml, respectively, on the 90th day postoperatively (P＜0.05). Conclusion PKRP is a safe and effective treatment for BPH patients, especially for the aged patients at high risk.