Based on a questionnaire survey regarding the perioperative management of transurethral resection of the prostate (TURP) in 1,213 educational institutions of the Japanese Urological Association, the relationships among clinical pathway usage, several perioperative management settings and institutional backgrounds were investigated. The clinical pathway was frequently used in the Tokai-Hokuriku and Chugoku-Shikoku districts, in national or public hospitals, and in hospitals with 31 or more TURP annually, but infrequently in hospitals having less than 200 beds, less than 10 beds for urology, one urologist alone in the hospital, not having a computerized medical system or not having an ICU and/or Department of Anesthesia. Logistic regression analysis revealed six significant backgrounds affecting clinical pathway usage: district (Tokai-Hokuriku, Chugoku-Shikoku) , university hospitals, hospitals having less than 10 urology beds, annual TURP for only 1-20 patients, absence of computerized medical system and absence of ICU. Although the relationship between clinical pathway usage and duration of fluid infusion was statistically significant, the difference was clinically very small. The various settings of perioperative management were significantly affected by the institutional background: number of urologists, ICU, and district, which was the special factor in multiple regression analysis. lt is not thought that the perioperative management of TURP could be standardized in Japan, when a clinical pathway established by each hospital is used in each hospital.