Abstract: Objective: To evaluate the role of SKATER tube one-step cystoctomy in the operation of transurethral resection of the prostate (TURP) in high-risk patients with big-size prostate. Methods: A retrospective analysis of 38 cases, which were all big volume and high-risk patients, underwent TURP operation. Eighteen cases underwent suprapubic cystostomy, 20 cases did not undergo cystostomy. The operating time, resected prostatic tissue volume, blood loss, the time of pull out urinary catheter and average stay hospital in the two groups were compared. Results: All suprapubic cystostomy and all TURP operations were completed successfully. The operative time of one-step bladder puncture nephrostomy in cystostomy group of time was (3.0 ± 0.5) min. Intraoperative blood loss, removal of the prostate volume between two groups were similar (P> 0.05). There were no occurrence of water intoxication or transurethral resection of prostate syndrome. The TURP surgery time, removal of the catheter time and hospital stay time in cystostomy group than non-cystostomy group was significantly shorter (P <0.05). Followed for 2 years to 3 months in patients with postoperative recovery were good and smooth urination. There were no frequent urination or urgency or dysuria or urinary incontinence. Conclusion: Using SKATER tube to do one-step cystotomy in high-risk TURP patients with big-size prostate have the advantages such as easily to be operated, shorter recovery time and less complications.