**7.5 Standard surgical procedures**

TURP (transurethral resection of the prostate) is the hallmark of the urologist, the one against which other therapeutic measures are compared. It takes 20 to 30 minutes to resects an average gland weighing of 30 g and carry risks complications like bleeding, infections, retrograde-ejaculation, hospital stay, impotence and incontinence.

In patients presenting with renal failure due to bladder outflow obstruction, TURP restores normal voiding pattern in many cases. However renal failure due to bladder outflow obstruction tends to be more refractory and 57% of patients in Thomas *et* al. study were dialysis dependent after surgery. Only 3 of 14 patients experienced return to normal renal function post TURP (Thomas, Thomas et al. 2009).

Mortality following prostatectomy has decreased significantly within the past two decades and is less than < 0.25% in contemporary series (Holman, Wisniewski et al. 1999; Hahn, Farahmand et al. 2000). The risk of a TUR-syndrome (fluid intoxication, serum Na+<130 nmol/L) is in the range of 2%. Risk factors for the development of the TUR-syndrome are excessive bleeding with opening of venous sinuses, prolonged operation time, large glands and past or present smoking.

Open prostatectomy is the treatment of choice for large glands (>80-100 mL), bladder stones or if resection of bladder diverticula is indicated. Open prostatectomy involves the surgical removal (enucleation) of the inner portion of the prostate via a suprapubic or retropubic prostatectomy.
