Also, I just read a nice summary of this situation[*].
The authors make it clear that the first-line treatment for tophi should be uric acid lowering drugs including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase. However, they also note that some tophi cause “urgent complications” that might warrant surgery. Those complications include infection, ulceration, and nerve compression (e.g. carpal tunnel syndrome). Also, when tophi develop near joints, they can damage joints, restrict movement, and cause function loss.
Finally, they conclude that tophi removal by surgery is generally successful. Although they repeat the warning “surgery should be considered for the rare patient with impending or severe, debilitating complications”.
So, it’s worth repeating that anyone with tophi should be taking allopurinol, or similar, at a sufficient dose to get uric acid well below 5mg/dL. But, each patient must have dose monitored to ensure it is safe and effective for that individual.
Tophi, Surgery, Uric Acid Lowering Reference
Kasper, Isaac R., et al. “Treatment of tophaceous gout: When medication is not enough.” Seminars in arthritis and rheumatism. Vol. 45. No. 6. WB Saunders, 2016.