Benign prostatic hyperplasia (BPH) is a common clinical entity in elderly men. We review the epidemiology of BPH and the mechanisms by which it causes bladder outlet obstruction. The currently available medical therapies are examined with respect to mechanism of action, effectiveness, side effects, and cost. They are briefly compared with the more traditional treatment options of watchful waiting and transurethral prostatectomy. A logical approach to the treatment of symptomatic BPH is discussed.