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Do I need surgery for my enlarged prostate?

Q: I have an enlarged prostate. The ultrasound report says: Right kidney measures 120 X 49 mm and Left kidney measures 109 X 46 mm. Both kidneys appear normal in echo texture and size and there is no hydronephosis or calculi. Corticomedullary differentiation is maintained. Urinary bladder appears normal. No evidence of any mass or calculus seen. Prostrate is enlarged in size, median lobe is projecting into base of bladder. Size-51 x 47 x 45. Weight-60.9 gms. Post void residual urine: 72 cc. No evidence of free fluid is seen. IMPRESSION: Prostatomegaly grade II. About three years back the report was almost the same except that post-void residual urine was 60 cc and the prostate weight was 36 gms. I am taking BP medication for the last several years (1 tab ESAM-AT i.e. Atenolol 50mg and S-Amlodipine Besylate 2.5 mg) and am currently on Prazosin tab (Prazopress) 1mg in the morning and 1mg at night (sometimes 2 mg). I have problem of polyurination which is controlled with the medicines but sometimes even with medicine the problem occurs. Do I need to go in for operation for removal of enlarged prostate? If yes, the old open surgery or the current laparoscopy would be better? If I don't go in for operation what is the worst which can happen to me?

A:At present you don't seem to have any absolute indication for surgery. I need to have a look into your PSA report and uroflowmetry. In the future the need for surgery may arise if you are not satisfied with the response to medications you are taking. The gold standard in prostate surgery today is TURP (transurethral resection of prostate) which the common man knows as laser surgery which is a misnomer. You need to follow up with your urologist every 3 months till you are on medical therapy. There are drugs which can be added to your treatment to reduce the size of your prostate after seeing your PSA report.

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