Lower urinary tract symptoms are common in the male population over 50 years of age. While in the majority of patients there are no sinister underlying abnormalities, it is important that men are educated to present for investigation and management at an early stage. Shared care between hospital services and primary care has resulted in significant improvements in patient care over the last 10 years. Clarification about the terminology used and the risk factors for progression has led to more appropriate targeting of treatment to those men who will benefit most. Further research into the natural history of benign prostate and bladder conditions will yield further improvements.