The Male Health Center - Urination & Men

New Treatments for an Embarrassing Problem

Middle-aged and older men with prostate problems have a number of new options.
Of the many male health problems I treat, urination difficulties are by far the most common. Among men 50 and older, about one in three has one or more of the following symptoms:

frequent need to urinate
difficulty starting a stream
stopping and starting
dribbling
reduced size and force of stream
sensation of incomplete emptying

Most urination problems in men can be blamed on their prostate gland—a walnut-sized mass that surrounds the urethra just below the bladder. As we put on years, the prostate may grow or become less flexible than it was when we were young, restricting the flow of urine. In a few cases, the situation is truly life-threatening. resulting in kidney damage. But in most cases the problem is more irritating than it is dangerous. Make no mistake, though, benign prostatic hyperplasia (BPH) can make a man's life miserable.

Treatments for BPH have evolved significantly over the years. Until the development of surgical approaches, early in the 20th century, castration was the only option. And in the last 25 years, open surgery has been largely replaced by the so-called "roto-rooter" procedure, where the prostate is removed from the inside by working with an instrument inserted through the urethra. Yet, although it's a big improvement, the through-the-penis operation still requires a few weeks off work and several months for complete recovery, and it is not without occasional complications.

In the last year, a number of developments have dramatically improved the options for men with BPH. First, two new drugs have been approved. Hytrin relaxes the muscles of the prostate, which improves urination in about 70 percent of men within about two weeks. Proscar actually shrinks the prostates of between 33 and 45 percent of men within about six months of beginning to take the drug.

A number of my patients are now opting to try these medications before resorting to surgery, and many are very pleased. It remains to be seen whether they just postpone more invasive treatment. But even that may be a boon, since new prostate-removal options—such as laser treatments—are being developed that hold great promise. With drugs, many men may be able to get along fine until these new treatments are perfected.

If the symptoms I listed above sound uncomfortably familiar, talk to a urologist. There's never been a better time to be a man on the go.

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