OBJECTIVE: To evaluate the frequency of urological and non-urological abnormalities detected on routine renal and abdominal ultrasonography in patients undergoing surgery for benign prostatic hyperplasia (BPH) and to see if they affected the intended decision for prostate surgery. METHODS: Medical records of 250 patients who underwent open or endoscopic surgery for BPH at Nishtar Hospital, Multan, Pakistan between May 2003 and December 2004 were studied. All patients had abdominal ultrasonography performed during routine preoperative workup. The frequency of urological and non-urological conditions detected on ultrasonography was calculated and the effect of these conditions on the intended decision for prostate surgery was observed. RESULTS: In 102 patients (40.8%) urological and in 8 patients (3.2%) non-urological abnormalities were detected by ultrasonography. Urological conditions detected included uni/bilateral hydronephrosis (34 pts), vesical stones (34 pts), renal cysts (15 pts), renal stones (6 pts), small shrunken kidneys (2 pts), renal tumour (1 pt) and bladder carcinoma (1 pt). Non-urological conditions included gall stones (4 pts), liver abscess (2 pts), hydatid cyst (1 pt) and liver carcinoma (1 pt). CONCLUSION: The study shows that a sizeable number of patients (44%) had urological and non-urological conditions detected by renal and abdominal ultrasonography. Most patients had benign conditions but three of these patients had potentially life threatening conditions (renal, bladder and hepatic carcinoma) detected by sonography that were unrelated to the prostate. However, in only one patient (0.4%) with bladder carcinoma, surgery for prostate was postponed and bladder tumour was dealt with prior to transurethral resection of prostate (TURP). Various conditions detected by ultrasonography would have been missed if it had not been performed. As ultrasonography is a non-invasive, cost-effective and quite a safe imaging technique, in author's opinion abdominal and renal tract evaluation by ultrasonography should be routinely performed in patients undergoing surgery for BPH.