With aging, a man’s prostate enlarges, often causing him to get up at night to urinate and to have increasing difficulty starting to urinate.

The prostate is a round gland that surrounds the tube that leads from the bladder to the outside. As it enlarges with aging, it squeezes the urinary tube and can make it very difficult for urine to pass to the outside. Other symptoms may include frequency of urination, urgency to urinate, and blood in the urine. In some cases, Benign Prostatic Hypertrophy can cause urinary tract infections, bladder stones, and kidney and bladder damage.

Treatment options include:

Watchful waiting: Mild symptoms are best treated by doing nothing.
Medication: Alpha blockers relax muscles around the bladder and prostate to open the urinary tube, but they do not prevent further prostate enlargement. 5-alpha reductase inhibitors may help relieve symptoms only a little. Hytrin is can be used to relax the urinary muscles and Proscar can shrink the prostate.
Radiation: transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA) burn and destroy the inner prostate gland. As symptoms almost always return these procedures have only temporary benefits.

Surgery is the most effective treatment and also has the highest rate of side effects: Transurethral resection of the prostate (TURP) involves inserting a tube into the urinary tube and cutting prostate tissue around the urinary tube. A 1995 study in NEJM showed that TURP usually does not cause impotency or incontinence. It also showed that the majority of men who had this procedure got relief from their night-time urination and difficulty starting their streams. An incidental finding was that 10 percent of the patients had prostate cancer that was diagnosed only after surgery.
Transurethral incision of the prostate (TUIP) involves a surgeon making one or two small cuts in the prostate to relieve pressure.
Laser ablation and holmium laser enucleation (HoLEP) use a laser to destroy parts of the prostate. HoLEP is particularly promising because, of all the surgical options, it removes the most tissue possible without requiring an incision.
Open prostatectomy, in which a surgeon cuts through the perineum, is only for the largest and most damaging prostates as it is most likely to cause impotence and incontinence.

If you are a man who has to get up to urinate frequently at night and takes a long time to start his stream, check with a urologist. You may not need any treatment or you may find relief with drugs.