Objective To investigate the effect of smoking on lower urinary tract symptoms in middle-aged and older men.Methods A total of 331 middle-aged and elderly male patients admitted to the First Affiliated Hospital of Xinxiang Medical College for lower urinary tract symptoms (LUTS) who met the enrollment criteria were selected for the study, and the patients were divided into a non-smoking group (156 cases) and a smoking group (175 cases) according to their smoking status. The patients in the smoking group were divided into 1-10 cigarettes/day group (55 cases), 11-20 cigarettes/day group (59 cases), and ＞20 cigarettes/day group (61 cases), and the patients in the smoking group were divided into ≤30 years group (77 cases) and ＞30 years group (98 cases) according to the smoking age, and the smoking index was divided into ≤200 group (50 cases), 200 ＜ smoking index ＜ 400 group (46 cases) and ≥ 400 group (79 cases),and the International Prostate Symptom Score (IPSS) and Health Related Quality of Life Score (HRQOL) score questionnaires, urine flow rate (UF) examination and residual urine volume (RUV) measurement were collected to compare the differences between the four groups. Results In the smoking group, the total IPSS score, storage period score, HRQOL score, and RUV were higher than those in the non-smoking group, and the maximum urinary flow rate and mean urinary flow rate were slower than those in the non-smoking group, and the differences were statistically significant (P＜0.05); in the smoking group, the maximum urinary flow rate and mean urinary flow rate were slower in the group of patients with ＞30 years of smoking than in the group of smokers with ≤30 years of smoking, and the difference was statistically significant (P＜0.05),the maximum urinary flow rate and mean urinary flow rate were slower as the daily smoking volume increased, and the differences were statistically significant (P＜0.05). Conclusion Smoking aggravates lower urinary tract symptoms in middle-aged and older men, and it leads to a reduced quality of life