Lower urinary tract symptoms (LUTS) affect >60% of men and women aged >40 years. Symptoms may be classified as storage, voiding or post-micturition and have a variety of systemic, neurological, drug-related or urological causes. There is growing evidence that obesity and metabolic syndrome are linked to LUTS. Initial evaluation of LUTS should follow a structured system, with symptom scores and frequency–volume charts. Several features have been identified as risk factors for progression of LUTS, and stratification using these factors can aid in planning management.