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Should I undergo surgery for an enlarged prostate gland?

Q: I am a 63 years old man having enlarged prostate gland for the last 7 years. Symptoms are frequent urination and sometimes immediate urination as the urine pressure is heavy. The last ultrasound was done about 18 months back and the size of the prostate gland was 43 grams. I am taking Contiflo daily and the problem is under control with this medicine. If I miss taking the medicine then I have to go to the toilet quite frequently. Previously I was taking Flodart plus for a year and the size of the gland had reduced by 4 grams. My last prostate specific antigen (PSA) report was normal. The doctor has been insisting to go for surgery. Should I go for surgery even if my problem is under control by taking Contiflo? I have high blood pressure measuring 140/90 mmHg. Please advise.

A:Every male has a prostate since birth and its size may vary. The gland also shows some enlargement after the age of 50 years and this may be associated with some urinary symptoms. It is wrong to conclude that all urinary symptoms in males are due to prostate, as urine volume, the bladder and pathology in adjoining organs may contribute to urinary symptoms significantly. Most common urinary symptoms attributed to prostate are poor urine flow and interrupted stream (obstructive symptoms). Symptoms like urgency and frequency (irritative symptoms) in absence of obstructive symptoms, as in your case, are unlikely to result from prostate enlargement and more likely due to bladder stimulation from other causes. Decision to operate on prostate is usually not taken on its size as the prostatic size has a poor correlation with the urinary symptoms. Whenever in doubt, a urodynamic study would be a good test to judge whether obstruction is associated in patients with predominant irritative symptoms.

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