Male lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms that have a major impact on a patient’s quality of life. They are divided into voiding, storage and post-micturition. Historically, the pathophysiology of LUTS has been exclusively attributed to benign prostatic obstruction (BPO) due to benign prostatic hyperplasia (BPH). Available data suggest that the etiology of LUTS is multifactorial and complex with different organs involved. As such, it has been recognized that besides the mainstay of α blockers and 5α reductase inhibitors (5-ARIs), different classes of medications can be used in specific clinical circumstances. Patients mainly affected by storage symptoms may benefit from muscarinic receptor antagonists or the recently introduced β3 agonist mirabegron whereas the presence of coexisting erectile dysfunction in patients with LUTS may be an indication for phosphodiesterase 5 inhibitors (PDE5i) alone or in combination.