Open surgical simple prostatectomy has traditionally been the treatment of choice for symptomatic benign enlargement of the prostate.1 In 1894, Eugene Fuller performed a series of suprapubic prostatic adenomectomies in New York city. Eleven years later, he published an investigative work entitled The question of priority in the adoption of the method of total enucleation suprapubically of the hypertrophied prostate.2 However, it was not until 1912 that, thanks to the results obtained by Peter Freyer, this approach was popularized using a technique consisting of enucleation of the prostatic adenoma through an extraperitoneal incision in the wall of the bladder. This surgical technique did not change until 30 years later when Terence Millin described his technique for a retropubic simple prostatectomy in 1945. Millin developed the innovative trans-capsular approach, which spared the bladder from unnecessary incisions. This avoided the morbidity and complications associated with the vesicotomy. Later, endoscopic transurethral techniques superseded open surgery for the majority of cases of benign prostatic hyperplasia (BPH).4.6 Modifications of the standard transurethral resection, such as the bipolar transurethral resection, holmium laser resection, or potassiumtitanyl-phosphate (KTP) laser vaporization have successively been incorporated into clinical practice. These and other minimally invasive techniques are becoming increasingly popular, including transurethral needle ablation and thermotherapy, although the latter are typically reserved for small volume glands.7 The choice of technique depends on various factors unique to a given patient, including gland volume, patient age, patient preference, particular glandular anatomy (e.g. presence of median lobe), and institutional access to technology (e.g. availability of holmium laser). Gland volume is far and away the main driving force in the decision process. For instance, transurethral incision of the prostate (TUIP) is effective for small glands (. 30cc). For moderate-sized adenomas, transurethral resection of the prostate (TURP) is the gold standard. © 2011 Springer-Verlag London Limited.