The surgical management of BPH reflects the diversity of our society with early and late adoption from both patients and surgeons. The scarce body of evidence available in this area only allows to manage the extremes. Patients with mild symptoms rarely benefit from intervention while patients with a constrictive type of obstruction can easily lead to bladder decompensation; from a teleological standpoint, acute urinary retention can be considered protective of detrusor function. Different approaches can be used to relieve obstruction and patients sometimes report misleading communication from health care providers. Provided the one-size-fits-all approach is wrong, we need different techniques to cope with different prostate sizes and diverse patient comorbidities, mastering most of the available techniques is required for a free choice and an informed consent. “More is better” probably holds true for durability in this type of surgery although no one evidence is available and the priority remains to choose the surgical technique for the individual patient and shape it according to his needs. The learning curve for BPH surgery was known to be long and no shortcuts have been created yet.