TEL AVIV, Israel — Israeli Prime Minister Benjamin Netanyahu is having his prostate removed on Sunday, his office said, a procedure that comes as he manages multiple crises at once, including the ongoing war in Gaza and his own trial for alleged corruption.

Netanyahu, 75, is among a cohort of older world leaders, including U.S. President Joe Biden, 82, and President-elect Donald Trump, 78, whose health and physical fitness are under deep scrutiny both at home and abroad because of their advanced age and the effect that could have on their leadership.

Netanyahu, who has had a string of health issues in recent years, has gone to great lengths to bolster a public image of himself as a healthy, energetic leader. During his trial this month he boasted about working 18-hour days, even if those long hours are accompanied by a cigar. But as Israel’s longest-serving leader, such a grueling workload over a total of 17 years in power could also take a toll on his well-being.

The procedure has already had a fallout: Netanyahu’s lawyer Amit Hadad said in a letter to the court the Israeli prime minister would be fully sedated for the procedure and would be hospitalized for “a number of days,” asking that his three days of testimony this week be canceled. The court agreed.

Netanyahu’s office said that Justice Minister Yariv Levin, a close Netanyahu ally, would serve as acting prime minister during the procedure.

With so much at stake in the turbulent region, Netanyahu’s health in wartime is a concern for both Israelis and the wider world.

Prostate Issues Common for Older Men

According to Netanyahu’s office, the Israeli leader was diagnosed with a urinary tract infection on Wednesday stemming from a benign enlargement of his prostate. The infection was treated successfully with antibiotics but a procedure on Sunday will remove his prostate.

Complications from prostate enlargement are common in men in their 70s and 80s, Dr. Shay Golan, head of the oncology urology service at Israel’s Rabin Medical Center, told Israeli Army Radio. Golan spoke in general terms about the procedure and was not involved in Netanyahu’s care or treatment.

He said that an enlarged prostate can block proper emptying of the bladder, leading to a build-up of urine that can then lead to an infection or other complications. After medicinal treatment, doctors can recommend a procedure to remove the prostate to prevent future blockages, Golan said.

In Netanyahu’s case, because the prostate is not cancerous, Golan said doctors will likely perform an endoscopic surgery, which is carried out by inserting small instruments into a body cavity, rather than making any surgical cuts in the abdomen to reach the prostate.

The procedure lasts about an hour, Golan said, and recovery is quick. Golan also said that aside from catheter use for one to three days after the procedure, patients can return to normal activity without any significant limitations.

Netanyahu’s Health Issue

Netanyahu insists he is in excellent health and his office has worked to craft a public image that backs that up. It releases footage of him touring war zones in full protective gear flanked by gruff military officers, or meeting with defense officials on windswept hilltops in youthful dark shades and puffer jackets.

But that image was shattered last year when Netanyahu’s doctors revealed that he had a heart condition, a problem that he had apparently long known about but concealed from the public.

A week after a fainting spell, Netanyahu was urgently fitted with a pacemaker to control his heartbeat. Only then did staff at the Sheba Medical Center reveal that Netanyahu has for years experienced a condition that can cause irregular heartbeats.

That revelation came at a time when Netanyahu was dealing with massive anti-government protests. The news about a chronic heart problem stoked further anger and distrust at a time of extreme political polarization in Israel.

Last year, Netanyahu was rushed to the hospital for what doctors said likely was dehydration, where he stayed overnight, prompting his weekly Cabinet meeting to be delayed.

Earlier this year, Netanyahu underwent hernia surgery, during which he was under full anesthesia and unconscious. Levin served as acting prime minister during the operation.

Turbulent Time in the Region

As Israel’s leader, Netanyahu is at the center of major global events that are shifting the Middle East. With the dizzying pace of the past 14 months, being incapacitated for even a few hours can be risky in the current regional maelstrom.

Netanyahu will be in hospital at a time when international mediators are pushing Israel and Hamas to reach a ceasefire in Gaza as violence there rages on and fighting between Israel and Yemen’s Iran-backed Houthi rebels intensifies.

The health issue also shines a new light on Netanyahu’s age. Prostate issues are common and in many cases easily treatable. But they are prominent, especially among older men.

The procedure puts a dent in Netanyahu’s image of vigor at a time when he would want to project strength more than ever, both to an Israeli audience navigating constant threats as well as to Israel’s enemies looking to expose Israel’s weaknesses.