Male lower urinary tract symptoms (LUTS) are a common complaint in adult men. Male LUTS have multifactorial aetiology suggesting the importance of a systematic diagnostic evaluation. Its goal is the allocation of symptoms to the underlying pathology, which is frequently attributed to benign prostatic enlargement. In addition, other conditions might lead to male LUTS. As a part of the initial assessment a medical history determines the patient’s symptoms which further can be differentiated and quantified by symptom score questionnaires. Physical and digital rectal examination combined with an ultrasound of the lower urinary tract measuring post-void residual urine and urinalysis complete the basic evaluation of male LUTS. Frequency volume chart and bladder diary, measurement of prostate-specific antigen, evaluation of renal function, uroflowmetry, imaging of the upper urinary tract and the prostate, urethrocystoscopy and urodynamics are further diagnostic tools being performed when basic evaluation cannot clarify the causes of male LUTS.