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Objectives: To evaluate the safety and efficacy of 120-W high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) in the treatment of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia., Methods: Two experienced surgeons performed 120-W HPS laser PVP. The baseline characteristics, perioperative data, complications, and postoperative outcomes were evaluated at 3, 6, 12, 24, and 36 months postoperatively., Results: A total of 550 consecutive patients, with a mean age of 67.6 years, underwent PVP with a 120-W HPS laser. The mean prostate volume was 72.93 cm3, with a mean prostate-specific antigen level of 3.57 ng/mL. The mean operative duration and the mean applied energy was 61.3 minutes and 164.06 kJ, respectively. No major complication occurred intraoperatively or postoperatively. The mean follow-up was 17.80 months. Significant improvements were observed postoperatively in the mean International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and postvoid residual urine volume. The mean catheterization time was 18.5 hours. The complications included delayed hematuria in 26 (4.8%), recatheterization in 24 (4.4%), reoperation owing to residual prostatic adenoma in 46 (8.5%), urethral stricture in 19 (3.5%), and bladder neck contracture in 6 (1.1%) patients., Conclusions: PVP with a 120-W HPS laser for benign prostatic hyperplasia has been proved to be a safe and effective procedure for our patients, including those treated with oral anticoagulants. The functional outcome in larger prostates was similar to that in smaller glands., (Copyright © 2011 Elsevier Inc. All rights reserved.)