Objective To summarize and analyze the surgical evolution and clinical efficacy of benign prostatic hyperplasia (BPH) surgery. Methods A retrospective cohort study was used to analyze the clinical data of 2050 patients who underwent surgery for BPH in the Department of Urology, the First Medical Center of PLA General Hospital from January 2012 to August 2022. These patients were divided into 3 groups in chronological order: the early group (n=683), the middle group (n=683) and the late group (n=684). The cumulative time of patients in each group was from January 2012 to February 2017, March 2017 to September 2020 and October 2020 to August 2022. The indicators, such as age, hypertension, diabetes, serum cholesterol, serum triacylglycerol, serum high-density lipoprotein cholesterol, body mass index (BMI), preoperative prostate volume, prostate specific antigen (PSA), free prostate specific antigen (fPSA), operation time, preoperative hospital stay, postoperative hospital stay, postoperative bladder flushing time, postoperative indwelling time, cystostomy situation, intraoperative and postoperative blood transfusion, postoperative readmission rate, and postoperative pathology were collected and compared between 3 groups, and the annual trend of changes in the number of BPH surgeries and surgical methods was analyzed. Results Transurethral resection of prostate (TURP) and TURP+laser resection decreased year by year, while transurethral laser resection of prostate increased and became the mainstream prostate resection method in recent two years, accounting for more than 90%. The patients in the early, middle and late groups were (69.7±7.9) years old, (68.7±7.4) years old and (69.8±8.5) years old (P=0.027); the operation time was 108.0(80.0, 130.0) min, 80.0(60.0, 110.0) min and 75.0 (60.0, 100.0) min (P<0.001); the postoperative indwelling time was 4.1(2.7, 5.9) d, 3.9(2.9, 4.9) d and 2.7(0.9, 3.9) d (P<0.001); the rates of cystostomy were 68.8%, 66.6% and 5.0% (P<0.001); the intraoperative and postoperative blood transfusion rates were 4.5%, 3.1% and 0.9% (P<0.001); the preoperative hospitalization time was 5.6(3.8, 7.1) d, 4.7(3.5, 5.9) d, and 4.7(3.1, 6.7) d (P<0.001); the postoperative hospital stays were 5.7(4.8, 7.0) d, 4.7(3.0, 5.9) d and 2.8(1.0, 4.0) d (P<0.001), with statistically significant differences. Thirty-seven cases (1.8%) of BPH patients who underwent surgery in our center for 10 years were re-admitted after surgery, and 64 cases had postoperative pathological abnormalities or were diagnosed with prostate cancer, with a total detection rate of 3.1%. Conclusions Laser enucleation of prostate has become the mainstream surgical treatment of BPH in our center, and perioperative indexes such as operation time, hospital stay, postoperative catheter indwelling time, cystostomy rate, and surgical blood transfusion rate have shown a significant improvement trend.