Objective To explore the safety and efficacy of transurethral dual-wavelength laser vaporization to treat high-risk prostatic hyperplasia under transperineal local anesthesia guided by B-ultrasound.Methods The clinical data of 40 patients with high-risk benign prostatic hyperplasia (BPH) from December 2017 to June 2019 were analyzed retrospectively. The patients were treated with 980/1 470 nm dual-wavelength laser vaporization under transperineal local anesthesia guided by B-ultrasound. The operation time, intraoperative pain grade, bladder irrigation time and indwelling catheter time were calculated. The changes of vital signs and hemoglobin of patients 2 h before operation, during operation and 2 h after operation were compared. Meanwhile Maximum urinary flow rate (Qmax), residual urine volume (RUV) and international prostate symptom score (I-PSS) were compared preoperatively and 1, 6 month after operation.Results The operation time was (25.6 ± 13.2) min, the anesthetic effect of all cases were satisfactorily. There was no statistical difference in comparison of vital signs and hemoglobin changes at 2 hours before operation, during operation and 2 hours after operation (P > 0.05). Bladder irrigation time was (1.6 ± 0.5) d, the time of indwelling catheter was (3.3±1.2) d. Postoperative urinary tract infection occurred in 8 cases, urinary tract irritation occurred in 7 cases, which improved after symptomatic treatment. There were no complications such as urinary incontinence, dysuria and urethral stricture, there were no cases of blood transfusion and reoperation. The Qmax increased from (6.8 ± 2.4) mL/s preoperatively to (20.2 ± 1.4) mL/s postoperatively. The RUV decreased from (158.2 ± 43.2) mL preoperatively to (26.5 ± 14.3) mL postoperatively, the score of I-PSS dropped from (26.9 ± 1.4) preoperatively to (6.5 ± 1.7) postoperatively, which were statistically significant.Conclusion Transurethral dual-wavelength laser vaporization of the prostate under transperineal local anesthesia guided by B-ultrasound is a new method for the treatment of high-risk BPH patients, It has the advantages of short operation time, less trauma and quick recovery. It can prevent high-risk BPH patients from giving up surgery because of the risk of intraspinal anesthesia or general anesthesia.