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On call: Prostate surgery and nighttime urination

On call

Prostate surgery and nighttime urination

Q. I am a 66-year-old subscriber. When I had my annual checkup, my doctor discovered that my PSA had jumped to 5.8. A urologist diagnosed prostate cancer, and I decided to have my prostate removed. I've done fine since, with a PSA of 0 and perfect control of my urine — except that I have to get up to urinate two or three times every night, just as I did before surgery.

I thought that prostate operations were supposed to help with nighttime urination. What went wrong?

A. It actually sounds like everything has gone right.

Enlargement of the prostate, usually due to benign prostatic hyperplasia (BPH), can produce a variety of voiding symptoms. Many men complain of urinary urgency, slowness in initiating urination, a weak stream, and incomplete emptying of the bladder. Most of these symptoms respond well to therapy, either with prescription medication or surgery. But although nighttime urination, or nocturia, is usually blamed on the prostate, it often persists after treatment because it is often the result of age rather than prostate disease. In fact, older women get up at night just about as often as their male peers.

Why do so many senior citizens wake up at night to void? Many factors are responsible. As people age, subtle hormonal changes affect their kidneys, shifting some of the production of urine from day to night. With age, the bladder wall becomes stiffer, so it signals a feeling of fullness before it's even near top capacity. And since older people tend to sleep less deeply, signals from the bladder are more likely to interrupt the sleep cycle.

Since you can't turn back the clock, your best bet is to reduce your intake of fluids late in the day, especially after dinner. Avoid diuretics such as alcohol and caffeine. Make sure you can get from the bed to the bathroom without tripping or stumbling; clear away loose objects and phone or electrical wires, and use a nightlight that will show you the way without jarring you into full wakefulness.

A Japanese study of 120 prostate cancer patients shows that you are not alone. Although the radical prostatectomy helped remedy urinary urgency, hesitancy, incomplete emptying, and a weak stream, it did not change the number of nighttime urinations, for better or worse. But if you are a typical patient in these respects, you are ahead of the game in the most important symptoms, since some prostatectomy patients develop incontinence after the operation.

— Harvey B. Simon, M.D. Editor, Harvard Men's Health Watch

Last updated:	January 19, 2007