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Over a 2-year period patients presenting with acute urinary retention secondary to locally advanced prostate carcinoma (stage T3/T4) were randomized to one of two treatments. Ten patients underwent channel transurethral resection of prostate (TURP) and bilateral orchidectomy, 12 patients underwent bilateral orchidectomy alone. Treatment by channel TURP and bilateral orchidectomy was complicated by difficulties in voiding in four patients, one requiring a further TURP. Ten of the 12 patients were voiding well one month following bilateral orchidectomy alone. Only two patients in this group required TURP. In patients with acute urinary retention secondary to prostate carcinoma, in whom hormonal manipulation is thought appropriate due to bulk of local tumour or metastatic disease, channel TURP may confer extra morbidity and therefore be held in reserve for those patients unable to void after hormonal manipulation.