Clinical BPH as a disease has been defined as benign prostatic enlargement (BPE) [1,2]; however in clinical practice we still see many patients with no enlargement, with prostate volume less than 20 g still causing symptoms and obstruction [3]. How can this be explained? To solve the puzzle, we first need to redefine clinical BPH. We need to go back to the basic fundamental pathology of BPH, wh...