The classic paradigm of obstructive benign prostate hyperplasia (BPH) causing lower urinary tract symptoms (LUTS; BPH/LUTS) has been replaced by the notion that not only the prostate but also the bladder contributes to symptoms.

The severity of bladder outlet obstruction is closely related to the development of detrusor dysfunction associated with similar symptoms. Several explanations have been set forth to explain the onset of detrusor overactivity, including increase in sympathetic stimulation, supersensitivity to acetylcholine, local changes producing segmental contractions, and increase in nerve growth factor. Metabolic syndrome, defined as abdominal obesity associated with hyperinsulinemia, insulin resistance, and two additional cardiovascular risk factors, is associated with urologic disorders such as hypotestosteronemia and erectile dysfunction. A growing body of evidence suggests that it is also associated with BPH and LUTS.

These new concepts should be used to design novel treatments for BPH/ LUTS. Published by Elsevier B.V. on behalf of European Association of Urology.