Purpose: To compare the safety and efficacy of thulium laser enucleation of the prostate (ThuLEP) with plasmakinetic enucleation of the prostate (PKEP). Methods: A total of 127 patients with benign prostatic hyperplasia (BPH) were randomized to either ThuLEP (n = 61) or PKEP (n = 66). All patients were assessed preoperatively and followed up at 3, 6, and 12 months postoperatively. Baseline characteristics of the patients, perioperative data, postoperative outcomes, and complications were recorded. Results: The decrease in hemoglobin level and the catheter time were statistically significantly lower in the ThuLEP group compared with the PKEP group (0.80 +/- 0.49 vs 0.99 +/- 0.52, p = 0.037, and 1.85 +/- 0.94 vs 2.28 +/- 1.34, p = 0.042). There were no statistical differences in complications between the two groups (p > 0.05). There was a significant improvement in 3, 6, and 12 months' parameters compared with preoperative values (p < 0.001). Assessment at the 12-month follow-up showed no difference in urinary parameters between the two groups. Conclusions: ThuLEP and PKEP are both safe and efficient procedures for the treatment of patients with BPH. Compared with PKEP, ThuLEP provided less risk of hemorrhage and shorter catheter time, although the differences may be of little clinical relevance. Further well-designed trials with extended follow-up and larger sample size are needed to draw final conclusions about the efficacy of the two procedures.