LAUSR

Part one of this special issue dealt with the historical development, epidemiology, aetiology and pathophysiology of clinical benign prostatic hyperplasia (BPH). With the current definition that clinical BPH is prostate adenoma/ adenomata (PA) causing a varying degree of obstruction irrespective of symptoms, the disease can be diagnosed with transabdominal ultrasound in the clinic with confidence and managed accordingly. This definition of clinical BPH would help explain some of the puzzles in lower urinary tract symptoms (LUTS)/BPH, such as why small prostates can cause significant obstruction while big prostates may not have obstruction [1]. Part two of this issue focuses on the differential diagnosis of underactive bladder as a cause of male LUTS and poor uroflow [2]. Various ways of assessing patients with male LUTS/BPH with non-invasive ultrasound d measuring bladder wall thickness, estimated bladder weight, intravesical prostatic protrusion (IPP) and resistive index d are also reviewed [3]. IPP still stands out as the most promising method as it is the cause of clinical BPH and the degree of IPP is related to benign prostatic obstruction (BPO) and therefore progression of the disease. Alpha blockers do not prevent progression. Only the 5-alpha reductase inhibitors (5ARIs) have been proven to be useful in preventing progression and reducing the size of the PA [4]. But while 5ARIs can reduce the size of the PA, they do not correct the shape and thus some patients may still not respond to the medical treatment. Currently there are many minimally invasive methods available for clinical BPH treatment apart from surgery. The use of Botox injection remains controversial, but it may have a role in the management of small PA [5]. Prostate urethral lift has shown good results but long-term follow-up for further assessment is needed. Many other devices are still investigational. Of these, aqua-ablation with high pressure water jet appears to be promising [6]. For patients with severe BPO affecting the voiding function (persistently high postvoid residual urine more than 100 mL) or those with storage dysfunctions (frequency