Objective To evaluate the efficacy and safety of tadalafil 5mg in the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Methods Randomized controlled trials (RCTs) were collected via computer-based and manual retrieval. The computer retrieval was limited to the time of database establishment until October 2018, and no limit was set for langauge. The databases searched included Wanfang database, China Journal Full-text Database (CNKI), China Science and Technology Periodical Database (VIP), China Biomedical Literature Database (CBM), EMBASE, PubMed, Cochrane. Library, and Clinicaltrials.gov. Quality assessments were performed for studies that met the inclusion criteria, data were extracted, and a meta-analysis was performed using RevMan 5.3. Results Included for analysis were 9 RCTs with a total of 3501 patients, 1758 being treated with the tadalafil 5mg and 1743 with placebo. Compared with placebo, tadalafil 5mg reduced the International Prostate Symptom Score (IPSS) [MD=-1.79,95%CI (-2.19, -1.39)], improved quality of life (IPSS-Qol) [MD=-0.26,95%CI (-0.36, -0.16)], but did not lead to significant improvement in maximum urinary flow rate (Qmax) [MD=0.15,95%CI (-0.35,0.64), P=0.55]. The proportion of patients who withdrew due to adverse events was not significantly increased in the tadalafil 5mg group [RR=1.54,95%CI (0.96,2.49), P=0.08, I²=0%]. Conclusion Tadalafil 5mg can improve the LUTS in the patients with BPH and is well tolerated.