Urological operations are commonly performed in the lithotomy position
. A rare, but serious, complication is the compartment syndrome, which
can result in neurovascular damage and permanent disability or limb l
oss. We describe two cases of compartment syndrome. One arose after tr
ansurethral resection of the prostate, and the other after an operatio
n to change a transsexual patient from man to woman. The literature is
reviewed, and the causes of the syndrome and possible ways of prevent
ing serious consequences to the patients affected are discussed.