Lower urinary tract symptoms (LUTS) in older men are common and often bothersome, resulting in a significant use of healthcare resources. Symptoms were thought to be secondary to benign prostatic obstruction (BPO) or benign prostatic enlargement (BPE). However, it should be noted that such storage symptoms are also seen in men without enlarged prostates and in women. These symptoms may be caused by detrusor overactivity, non-urological conditions, medications, or lifestyle factors. Management of BPO constitutes to a significant proportion of a urologist’s workload, and will continue to do so with an increasingly ageing population. This review aims to provide an overview of the current understanding of BPE and male LUTS as well as investigations and treatment options. The primary source of data was PubMed, this was searched using Boolean strategies and by scanning a list of related articles. We also examined secondary sources from reference lists of retrieved articles.