QUESTION: Dr. Leslie, I hope you can suggest a course of action.

I've suffered from BPH for a great many years but until now it's been manageable.

I take finasteride 5 mg daily and alfuzosin 10 mg daily. I currently need to get up to urinate about 6 times a night. These 6 times always occur in the latter part of the night. I try to sleep a total of 7 hours daily. To reduce my nightly sleep time I take a daily nap, but for whatever reason that does not usually last more than about half an hour. (The BPH does not affect my naps.)

I take no food or liquids after 7 pm or so. I go to bed about 11:30 pm.

I would like to avoid surgery.

ANSWER: Richard:

Your next step is a voiding diary for 24 hours.  You need to write down the amount you void in mL and the time for a total of 24 hours.  We need to know if your problem is bladder overactivity possibly related to your prostate issues, or a urinary volume problem.  Once this is known, then the appropriate steps can be taken.

Assuming your bladder empties well and the flow is good, treatment is likely to be either a bladder relaxing agent (for overactivity) or some type of urinary volume control such as DDAVP or antidiuretic hormone to temporarily reduce urine production.

Then arrange to see a urologist for help.

---------- FOLLOW-UP ----------

QUESTION: Many thanks, Dr. Leslie. Are you suggesting that I may not have BPH at all?


I cannot determine if you have BPH or not based on the information submitted.  But it doesn't matter: you are already on maximum medical therapy for BPH which may or may not be a contributing factor.  Either way, the only reasons why you are going to get up so often at night to void are:

1) Too much urine production (polyuria) which is often due to diabetes or hormone issues.
2) Bladder overactivity which can be due to BPH.
3) Sleep issues.  You wake up and void but not due to urinary problems.

Do the 24 hour voiding diary first, then ask your physician.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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