Objective To assess the efficacy and safety of photoselective vaporization of the prostate with 120W green light laser in the treatment of benign prostatic hyperplasia (BPH) in high-risk aged patients. Methods Clinical data of 86 high-risk patients with a mean age of 76.5 (ranging from 70 to 93) years who underwent photoselective vaporization of prostate (120W) for the treatment of BPH in our department from May 2010 to December 2012 were collected and retrospectively analyzed. Results All surgery procedures were completed successfully. The operation time was (28.7±9.4)min, and intra-operative blood loss was (14.8±9.0)ml, with no one requiring blood transfusion intra-operatively. The duration of post-operative indwelling catheter was (2.0±0.7)d, and hospitalization time was (3.2±1.1)d. Postoperative complications included transient dysuria, mild urinary tract irritation, secondary hematuria, and transient urge incontinence. All these symptoms were relieved after treatment. There were significant differences in International Prostate Symptom Score (IPSS), maximum flow rate and residual urine volume at 1 and 6 months after operation compared with pre-operation(P＜0.01). Conclusions Photoselective vaporization of prostate (120W) has advantages of shorter operation time, less blood loss, rapid recovery, and high safety. It is an ideal and minimally invasive approach for high-risk elderly patients with BPH.