Surgical therapy remains the definitive treatment in patients with benign prostatic hyperplasia sequelae. Many patients with a markedly enlarged prostate are often not amenable to minimally invasive therapies. In these patients open prostatectomy is a preferred treatment. Most studies of this procedure are quite dated. Therefore, we describe the clinical results and complications of open prostatectomy performed in a modern setting using serum prostate specific antigen, the American Urological Association symptom index and quality of life scores to determine outcomes.