How does a urologist determine the size of the prostate and best way to remove it?

Intra-rectal ultrasound techniques appear useful in objectifying prostatic hypertrophy. Most reputable urologists are using total prostatectomies as procedures of last resort. Medical treatments are preferred.

Size determined by ultrasound or CT. And total removal is by an open operation or robotic prostatectomy. There is no 'one size fits all' method selected by expertise of surgeon, size of prostate , medical co-morbidities of patient and other factors