Diagnosis and management of benign prostatic hyperplasia (BPH) in neurologically impaired patients is challenging for the urologist. The assumption that lower urinary tract symptoms (LUTS) in these patients are invariably due to the underlying neuropathology may result in inadequate treatment of BPH. However, ignoring the underlying neurological condition can exacerbate symptoms and dramatically worsen quality of life. It is therefore crucial to understand the pathophysiology underlying the neurological disease as well as the impairment caused by benign prostatic hyperplasia.