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Menino’s surgery for benign prostate disease

Aram Boghosian for The Globe

Mayor Thomas Menino had surgery last Friday to fix a problem with his prostate that most men over age 60 experience.

Doctors frequently prescribe medications such as finasteride (Proscar) as an initial therapy to treat symptoms such as urgent, frequent urination — especially in the middle of the night — difficulty starting the flow, or a weak urine stream that leaves the bladder partially full.

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If those don’t work, a number of minimally invasive procedures can heat and destroy excess prostate tissue using microwave, lasers, or radiofrequency energy, by inserting a tiny device through a catheter.

These tend to have fewer side effects than surgery but they tend to be reserved for milder cases because they aren’t as effective at providing a permanent fix, according to Dr. Michael Naslund, chief of urology at the University of Maryland Medical Center in Baltimore.

Menino had a more extreme and less commonly used open-surgical procedure called a suprapubic prostatectomy, where an incision is made directly into the prostate gland to scoop out the tissue, leaving the gland’s capsule behind.

“It’s not an uncommon procedure to do for men who have a very, very big prostate,” said Dr. James Ulchaker, a urologic surgeon at the Cleveland Clinic. “It can be a very good procedure with a very good functional outcome.” Side effects can include infections, bleeding, incontinence, and urine leakage.

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