Background: Urinary bladder stones may be a primary stone formed in the urinary bladder or migrating calculus from the upper urinary tract. Bladder stones become more symptomatic when associated with infra-vesical obstruction.The most common cause of infra-vesical obstruction in elderly men is benign prostatic hyperplasia. Benign prostatic hyperplasia can be identified clinically by a complex of symptoms. These symptoms,  known as lower urinary tract symptoms, range from incomplete emptying, weak stream, nocturia, and increased urinary frequency, and can potentially progress to urinary urge incontinence and urinary retention. About 35% of elderly men above fifty years will seek medical advice and have medical treatment for infra-vesical obstruction. About 24% of patients with mild to moderate LUTS will undergo surgical management for BPH. The strong association between infra-vesical obstruction due to benign prostatic hyperplasia and urinary bladder stones has led to the dogma that any BPH associated with bladder stones should be managed surgically. This study aims to review the etiology, pathogenesis, and management options of infra-vesical obstruction caused by BPH, urinary bladder stones, or both. We have searched literature in the American National Center for Biotechnology Information (NCBI), PubMed, Google scholar, Egyptian bank of knowledge,and science direct.