Our objective is to evaluate the effect and safety of transurethral resection of prostate (TURP) and U100 laser lithotripsy for benign prostate hyperplasia patients with complicating bladder lithiasis. 79 cases with bladder outflow obstruction (BOO) secondary to benign prostate hyperplasia (BPH) complicating bladder lithiasis were collected. Based on the different ways of bladder lithiasis lithotripsy, the patients were randomized into two groups: the punch lithotrite group (43 cases) and the U100 laser group (42 cases). All patients were assessed perioperatively and followed at one month postoperatively. The preoperative and postoperative parameters included international prostate symptom score (IPSS), maximum urinary flow rates (Qmax), postvoid residual urine (PVRU) volume, patient... baseline characteristics, perioperative data, and postoperative outcomes. In the two groups, the IPSS scores and the maximum flow rate (MFR) showed significant differences when compared to the preoperative data (P﹤0.05). The stone-free rate (97.2%) in the U100 laser group was significantly higher than that in the punch group (62.8%), with a statistical difference (P＜0.05). For stones ﹤1.5 cm, the time of lithotripsy and stone-free rate in the U100 laser group was not statistically different as compared with those in the punch group. For stones >2.5 cm, the lithotripsy efficiency and the stone-free rate in the U100 laser group increased significantly with a statistical difference when compared with those in the punch group. In conclusion, the therapeutic effects of the two lithotripsy approaches showed no difference for calculi with a diameter <1.5cm. While for calculi with a diameter >2.5cm, the U100 laser lithotripsy was recommended. We have shown that the U100 laser lithotripsy, when combined with TURP, is an effective and safe treatment for BPH with bladder lithiasis.