As you slide out of bed for your fourth trip to the toilet tonight, you may be ready to do almost anything to get a good night’s sleep.

For men with similar night-time symptoms, prostate surgery has for many years offered a tempting solution. Before you make a hasty choice, however, it’s important to explore your options.

The connection between urinary symptoms and prostate surgery requires some knowledge of anatomy. Similar in size and shape to a crab apple, the prostate is located at the base of the bladder. When it’s normal size–as it usually is for the first 50 years of a man’s life–the prostate gland is loosely wrapped around the urethra, the tube that carries urine from the bladder through the penis. By age 55, at least a quarter of males experience a non-cancerous enlargement of the prostate gland, known as benign prostatic hyperplasia (BPH), and the excess tissue puts pressure on the urethra, sometimes restricting the flow of urine.

Most older men recognize at least some of the symptoms: straining to get urination started, a weaker stream, some dribbling at the end and sometimes a feeling that you haven’t completely emptied the bladder. Because of straining, the muscular wall of the bladder eventually becomes thicker and less capable of storing urine effectively, creating the need to urinate frequently (polyuria), particularly at night (nocturia).

Most men simply learn to live with these symptoms, but when they become severe enough to interfere with sleep or daily life, it’s time to get a diagnosis.

There are other reasons for aging males to experience urinary symptoms. Frequent urination may be caused by an over-active bladder rather than an enlarged prostate. Excessive urination at night can be an effect of hypertension or an age-related change in circadian rhythms.

Even if the prostate is involved, lifestyle changes–such as eating and drinking less after 6 p.m.–may help. To keep the problem from getting worse, it’s important not to delay urination when the urge is present and to empty the bladder completely each time.

More serious consequences that often develop, particularly if the bladder is not completely emptied, include infections, bladder stones or other damage to the bladder and kidneys. John found himself unable to urinate at all–a serious condition known as acute urinary retention. After a trip to the emergency room, he was catheterized and then scheduled for surgery.

Surgical treatment for BPH involves removal of tissue from inside the prostate, a procedure known as transurethral resection of the prostate (TURP). The surgeon goes into the prostate with a long, thin instrument inserted through the penis and urethra. After recovery, 90 to 95 percent of men with severe symptoms notice marked improvement and require no further treatment for at least five years.

Long-term complications can include erectile dysfunction, incontinence and retrograde ejaculation–ejaculation of semen into the bladder rather than out through the penis. The latter is not dangerous but can be emotionally troubling and a cause of infertility.

The decline in the number of surgical procedures performed over the past decade is due primarily to the approval of two classes of drugs to treat BPH.

A 5-alpha reductase inhibitor such as finasteride (Proscar) or dutasteride (Avodart) can shrink an abnormally large prostate, relieving symptoms and preventing episodes of acute urinary retention. Another approach is the use of an alpha blocker such as doxazosin (Cardura), terazosin (Hytrin) or tamsulosin (Flomax) to reduce tension in smooth muscle cells, thus allowing better urinary flow.

Which class of drug is prescribed usually depends on the size of the prostate and individual symptoms. The five-year MTOPS study found that combination therapy (finasteride plus doxazosin) was safe and more effective than either drug used on its own.

At least when symptoms are moderate, the best treatment may be watchful waiting. If symptoms seem unbearable this week, they may get better, at least temporarily, in the weeks or months ahead.

See your physician at least once a year. In the meantime, don’t consume large quantities of fluids or alcohol at one time and avoid tranquilizers and over-the-counter remedies that contain decongestants.

BPH will not develop into prostate cancer, and it does not increase the risk of cancer, although both can exist at the same time. In most cases, the greatest risks are bladder infections, acute urinary retention...and the effects of poor sleep.