Elderly men presenting with Lower urinary tract symptoms (LUTS) constitutes around a third of urological practice with prevalence of LUTS as high as 10–41 % in men older than 40 years. Its adverse impact on the Quality of Life (QoL) makes it imperative for the clinician to guide therapy based on sound diagnostic principles. Clinical evaluation of LUTS secondary to BPH involves International Prostate Symptom score (IPSS) assessment, digital rectal examination (DRE), urodynamics and sonological evaluation of prostate. Our study aims to correlate the grades of prostatomegaly on DRE and prostate volume on sonography with LUTS assessed by IPSS in elderly males.