Does your growing prostate have you up at night?

As men age, their prostates get larger, eventually causing problems with urination, since the urethra passes right though this gland, which sits below the bladder and contributes secretions to semen.

A normal prostate is often described as the size of a walnut. It weighs about 25 grams, said Andrew C. Kramer, MD, FACS, a urologist with Urology Associates of Cape Cod. Prostates can grow to be two to four times that size or larger, and squeeze the urethra. The urine stream can slow; the bladder may not empty as well. Men might be up several times a night to go to the bathroom.

“The symptom that brings men in is getting up at night,” said Dr. Kramer.

Men complain to him that it not only interrupts their sleep but disturbs their partner’s sleep as well.

Untreated, a blocked urethra could cause kidney failure or other problems, according to Dr. Kramer.

Medication Can Help

Growth of the prostate not related to cancer is called benign prostate hypertrophy or BPH. When discussing treatment options, Dr. Kramer said many men choose to first try medication to alleviate the problem. A popular medicine is Flomax (tamsulosin), one of a class of drugs called beta blockers that relax muscles in the prostate and bladder, according to Drugs.com. Flomax can cause dizziness and lightheadedness, and it may reduce the amount of fluid ejaculated during sexual climax, he said.

Another choice is Proscar (finasteride) which belongs to a second class of drugs called 5-alpha reductase inhibitors that block the male hormone promoting prostate growth, according to the National Library of Medicine’s MedlinePlus. Side effects may include decreased sexual desire and difficulties with erections and ejaculation, pain in testicles, and depression. It provides less symptomatic relief than Flomax, Dr. Kramer said.

For some men, pills provide relief for years, before continuing prostate growth prompts consideration of surgical procedures.

“Eighty percent will go for pills, or at least start with pills,” Dr. Kramer said. “Fifteen to twenty percent opt for a procedure.”

Surgery and Prostate Size

Several less invasive procedures are available for men with BPH in the medium-size range (prostate of 40-80 grams), according to Dr. Kramer, including one known as UroLift™.

“I’ve probably done close to a thousand of them,” he said.

With UroLift™, a device is inserted into the urethra and a series of clips are placed, usually two or three per side. There is no surgical removal of prostate tissue.

“Each clip has two brackets on it. One part goes on the outside of the prostate; you fasten the other to the inner wall of the urethra,” he said.

Prior to a procedure, Dr. Kramer said he does an ultrasound to determine prostate size, and a cystoscopy, using a scope inserted up the urethra, to check on the prostate’s structure.

“For some people (with medium-size prostates), lobes protrude into the bladder,” he said.

The UroLift™ procedure itself takes only 5-10 minutes, doesn’t require an overnight hospital stay and there’s no need for a catheter during recovery, he said. It also doesn’t cause retrograde ejaculation – ejaculation of semen into the bladder rather than out of the penis – that is a possible side effect of an older procedure called transurethral resection of the prostate or TURP.

“TURP is the gold standard,” Dr. Kramer said.

Also considered minimally invasive, TURP uses a scope to introduce a cutting device up the urethra. There the surgeon removes slices of prostate tissue, according to a September 4, 2023, National Library of Medicine’s StatPearls article. Afterward, a catheter is placed and the patient remains in the hospital overnight or longer, if necessary. The catheter is removed during a post-operative visit. Complications include retrograde ejaculation, but erectile function is preserved. In some cases, urinary problems may not be totally resolved, though most incontinence goes away within three months. As with any surgical procedure, there’s a risk of infection and bleeding.

Most candidates for TURP have prostates in the 75-80 gram range, though more skilled and experienced surgeons can perform the procedure on 100-150 gram prostates, according to the National Library of Medicine article.

Other procedures include using robotic or laser surgery, or a series of steam injections into the prostate, a technique called Rezum™, Dr. Kramer said.

Neither UroLift™ nor TURP cure BPH – prostates will continue to grow, but the procedures can provide long-term relief.

“It’s as good as a pill for a long time,” Dr. Kramer said of UroLift™, and without the side effects of drugs.