Two-micrometer laser resection of prostate-tangerine technique dissects whole prostatic lobes off the surgical capsular, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of 2-mu m continuous laser vaporization in the treatment of high-risk patients with benign prostatic hyperplasia (BPH) during the 24-month follow-up. The study included 248 patients with moderate to severe lower urinary tract symptoms who underwent 2-mu m continuous laser vaporization of the prostate. All patients were accompanied with different degree comorbidities and 94 patients were taking oral anticoagulants. BPH was successfully treated with 2-mu m continuous laser vaporization in all patients. Mean pre-operative prostate volume was 76 +/- 25.3 ml and mean operative time was 49.8 +/- 16.5 min. There were no major complications intra-operatively or postoperatively, and no blood transfusions were needed. About 20 patients (8.1%) needed bladder irrigation postoperatively. Average catheterization time was 2.0 +/- 1.8 days (range 1-5 days). Four patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6-, 12-, and 24-month follow-ups, maximum urinary flow rates (Qmax) increased from 6.9 +/- 1.7 to 19.1 +/- 4.2, 19.5 +/- 4.6, 19.4 +/- 4.6, and 19.5 +/- 4.1 ml/s, respectively. Mean International Prostate Symptom Scores (IPSS) decreased from 27.6 +/- 5.1 (pre-operation) to 9.2 +/- 2.6, 7.12 +/- 1.42, 6.18 +/- 1.32, and 6.25 +/- 1.30 at 3-, 6-, 12-, and 24-month post-operation, respectively. Two-micrometer continuous laser vaporization is a safe and effective surgical endoscopic technique associated with low complication rate in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS caused by BPH.