Major urologic surgery performed in the lithotomy position sometimes results in the serious complications of rhabdomyolysis and acute renal failure. A 54-year-old man with prostate cancer (weight, 84 kg; height, 171 cm; body mass index, 28.7) underwent radical perineal prostatectomy in the lithotomy position for 7 hours. On the first postoperative day, the patient complained of numbness and pain of both thighs with oliguria. Serum creatinine kinase and myoglobin levels were elevated. Bone scintigraphy on the second day, which was confirmed by MRI, showed extraosseous increased activity in gluteus maximus muscle regions compatible with rhabdomyolysis.