OBJECTIVE To explore the application of transrectal high-intensity focused ultrasound (HIFU) for treatment of benign prostatic hyperplasia (BPH). METHODS From Dec. 2002 to Dec. 2006, 262 BPH patients underwent transrectal HIFU ablative therapy. After the treatment, IPSS, QOL score, peak uroflow rate and prostatic volume measured by TRUS were used for evaluation. RESULTS After 1 to 3 years' follow-up, IPSS, QOL score, and prostatic volume all decreased, while the peak uroflow rate increased obviously (P<0.01). Mild hematuria was noted in all the cases after the treatment, and epididymitis was found in 7 cases (2.7%), short-term hematospermia in 66 cases (25.2%), retrograde ejaculation in 35 cases (13.4%), and urethro-rectal fistula in 1 case (0.3%). No urinary incontinence was found in these cases. TURP was performed in 18 cases (6.8%) in 3 years after the treatment due to an excessively large volume of the prostates or bladder neck contracture. CONCLUSIONS HIFU is effective and safe in the treatment of BPH which causes minimal invasion, absence of intraoperative bleeding, good tolerance and few complications, and is especially suitable in elderly patients.