Lower urinary tract symptoms (LUTS) occur commonly in older men and can have a significant effect on quality of life. Symptoms can be categorized as voiding, storage, or postvoiding in nature. A variety of symptom screening scales are available to categorize the nature and severity of the urinary symptoms. Erectile dysfunction (ED) symptoms frequently overlap with LUTS and treatment must address both conditions. Initial evaluation for LUTS and ED includes extensive questioning about symptoms, medication use, and medical history, followed by a targeted physical examination and basic laboratory testing. Treatment is focused on the origin of symptoms, which are frequently bladder hyperactivity, urinary retention, or prostatic hypertrophy. Common medication classes used to treat LUTS and ED include alpha-1 adrenergic blockers, anticholinergics, 5alpha-reductase inhibitors, and phosphodiesterase inhibitors. Combination medication therapy has been studied and is providing benefit in patients with more than one type of urinary dysfunction.