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Year : 2021  |  Volume : 37  |  Issue : 2  |  Page : 199-200

The grading and staging of clinical BPH for optimal care

Department of Urology, Naruvi Hospital, Vellore, Tamil Nadu, India

Date of Submission06-Mar-2021
Date of Acceptance18-Mar-2021
Date of Web Publication1-Apr-2021

Correspondence Address:
Nitin Kekre
Department of Urology, Naruvi Hospital, Vellore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iju.IJU_88_21

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How to cite this article:
Kekre N. The grading and staging of clinical BPH for optimal care. Indian J Urol 2021;37:199-200

How to cite this URL:
Kekre N. The grading and staging of clinical BPH for optimal care. Indian J Urol [serial online] 2021 [cited 2021 Jul 25];37:199-200. Available from:

Author: Foo KT

Year: 2020

Publisher: Foo KT

Pages: 204

ISBN: 978-981-14-6599-4

It gives me a great pleasure to review this book titled “The Grading and staging of clinical BPH for optimal care” by Prof. KT Foo, an outstanding urologist, a rare combination of a scientist surgeon and a philosopher. I have personally known Prof. KT Foo, a well-respected urologist and popular teacher and a founding member of the Urological Association of Asia. This book is the culmination of his lifetime work on bladder outlet obstruction caused by an enlarged prostate, which Prof. Foo defines as clinical benign prostatic hyperplasia (BPH). The term clinical BPH is defined as prostate adenoma causing bladder outlet obstruction with or without symptoms. Prof. Foo emphasizes that benign prostatic obstruction (BPO) is the result, not the cause and so cannot be termed as disease.

Prof. Foo, in his own philosophical style, based on personal experience and backed by some good quality studies, highlights the importance of intraprostatic protrusion (IPP) assessed by abdominal ultrasound as a reliable indicator of BPO (clinical BPH). It was his pioneering research work that brought focus on the role of IPP in clinical BPH. The staging of BPH into nine phenotypes based on IPP and prostate volume makes interesting reading and offers a new insight into how the structural alteration of prostate adenomas can influence clinical presentation and treatment. He describes the usefulness of flexible cystoscopy in the diagnosis of clinical BPH in comparison to urodynamic studies (UDS).

Prof. Foo's personal observations answer several questions like how to choose between doing a flexible cystoscopy or UDS in patients being planned for surgery. Does PSA actually increase with age? And is it possible for a certain subset of patients to forego medical treatment completely and directly opt for surgery based on these parameters.

The book is written in very simple, readable format almost like storytelling, in that the chapters progress very logically starting from defining what a disease is and how to approach a patient with clinical BPH, its grading and staging. What makes it unique is that unlike texts and journals where the material is strictly evidence based, this book offers an experience-based explanation and very pertinent learning points based on interesting case histories and even anecdotes from his personal life. We learn that enucleation of the prostate owes its existence to an incident where an intraprostatic stent got stuck in the bladder and the urologist accidentally found the right plane and enucleated the prostate.

The final chapter summarizes his entire philosophy of individualizing treatment provided to each patient based on the clinician's knowledge and experience. Treating a patient as an individual and not a case of BPH is more important than just attaching a diagnosis to him. He emphasizes that the art of medicine is no less important than the science of medicine, which is getting lost in investigation-oriented practice of medicine of today.

This book offers a different perspective to patient management and makes you think beyond the RCTs and meta-analyses. I personally agree and believe that an honest opinion formed by a lifetime of experience of an observant mind with sole intention of healing patient is invaluable. It is not a textbook on clinical BPH but a philosophical approach to the patient suffering from lower urinary tract symptoms. He is not only imparting knowledge but great wisdom. To sum up in his own words “if you wish to see further, then you must go up one more floor.”

I am sure this book will enrich our understanding and improve the management of patients with lower urinary tract symptoms. I would recommend this book to anyone who is interested in the personalized management of clinical benign prostatic enlargement.

My sincere best wishes to Prof. KT Foo and sincere thanks for this wonderful book,


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