For reasons not entirely known, the prostate gland starts to increase in size around age 50 and causes symptoms of difficulty with urination. The prostate gland is a walnut sized organ at the base of the bladder and surrounds the tube, the urethra, which transports urine from the bladder to the outside of the body. When the prostate gland grows, it compresses the urethra making urination difficult.
By the time men are in their 40s or 50s, many are already experiencing symptoms, such as having to get up at night to urinate. Into their 60s and 70s, they may have to get up two or three times.
In addition, an enlarged prostate can also result in other urinary symptoms such as having to go frequently during the day, having a weak stream or having to go urgently.
The “gold standard” is called a transurethral resection of the prostate (TURP), where an instrument is inserted up the urethra to remove prostate tissue that is blocking urine flow. It is sometimes colloquially referred to as a “roto-rooter” procedure. The purpose of the TURP to carve out the inner portion of the prostate and leave just the shell. The procedure allows a much stronger stream and men who have it will have to urinate much less frequently.
However, the procedure requires general anesthesia and a hospital stay. While it does not usually interfere with the ability to have an erection, more than half of those who have it will experience “retrograde ejaculation,” meaning that no fluid comes out of the penis during orgasm. Instead, the fluid goes into the bladder where it is eliminated during urination. Men will also have to wear a catheter for a few days after the procedure and will require several months before they can resume all activities including sexual intimacy and heavy lifting.
Similar procedures known as GreenLight Laser Treatment, which uses a high-energy laser to vaporize prostate tissue, and holmium laser enucleation of the prostate (HoLEP), which also uses a laser to destroy prostate tissue, are also available. They are pretty much the same in terms of outcomes. They just use different energy sources.
Now there is a new treatment, the UroLift, that doesn’t remove any tissue but relieves the compression on the prostate gland making urnation easier and reducing the symptoms. The procedure can be done in the office setting, does not require any catheter, and does not cause any sexual side effects or retrograde ejaculation.
Bottom Line: Many middle aged men have sympotms related to the enlarged prostate gland. There are multiple treatment options and men can plan to resume their activities after treatment for benign prostate disease.
If you are 50 or older and you have any of these symptoms and they are bothersome, talk to your doctor.