Commentary on “Solving the benign prostatic hyperplasia puzzle”

Benign prostatic hyperplasia (BPH) is a common condition affecting over 50% of men as they reach the 5th decade of their life [1]. While over half of these patients have symptoms, it is not clear why some of these men do while others do not. The article Solving the benign prostatic hyperplasia puzzle by Keong Tatt Foo [2], delves into the different conundrums urologists face when trying to treat their patients. The purpose of this commentary is to bring these issues to light to spur and guide further research efforts. First, why do some small prostates lead to bladder outlet obstruction while some large prostates do not? Sometimes the question is not how large the prostate is but what is its shape and anatomy. Although we tend to correlate lower urinary tract symptoms (LUTS) with benign enlargement of the prostate (BPE), in practice it is not uncommon to see patients with small prostates having severe LUTS [3]. The adenoma can affect two zones: the transitional and periurethral zone. The adenoma can then give rise to different degrees of obstruction depending on its location [3]. This can also occur with the subcervical adenoma in patients with a small prostate which is located below the bladder neck. This is not a bladder neck problem