|Year : 2023 | Volume
| Issue : 1 | Page : 23-26
Management of urethral stricture (Mutrapraseka sankocha) by Uttarabasti and oral medicines: A case report
Amarprakash P Dwivedi1, Bibek Kumar Mohapatra1, Anaya Pathrikar2
1 Department of Shalya Tantra, School of Ayurveda, DY Patil Deemed to be University, Navi Mumbai, Maharashtra, India
2 Department of Kayachikitsa, AVPM's Ayurveda Mahavidyalaya, Sion, Mumbai, Maharashtra, India
|Date of Submission||11-Feb-2022|
|Date of Acceptance||09-Feb-2023|
|Date of Web Publication||21-Mar-2023|
Dr. Bibek Kumar Mohapatra
Department of Shalya Tantra, School of Ayurveda, D Y Patil Deemed to be University, Navi Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Urethral stricture is a disease condition in which there is the narrowing of the lumen of the urethra. In established conventional medicine, the treatment includes urethral dilation, urethrotomy, and urethroplasty having varied prognoses. As per the Ayurvedic perspective, the condition can be correlated with Mutrapraseka sankocha (~urethral stricture). Uttarabasti (~intra urethral douche) is one of the effective procedures for urethral stricture. A single case study of 24-year-old male patient suffering from urethral stricture for four years has been illustrated here. The patient had complaints of straining during micturition, burning and dribbling micturition, and unsatisfactory urination along with the increased frequency of micturition. The patient has taken conventional treatment without significant improvement and approached for Ayurvedic treatment. After taking a detailed history and thorough examination, it was planned to administer Uttarabasti using the combination of Tila taila (10 ml), Saindhavadi taila (3 ml), Yavakshara taila (2 ml) for eight days along with Gokshuradi guggulu (500 mg) twice a day with lukewarm water, and Varunadi kwatha (30 ml) twice a day with an equal amount of water internally for 30 days. The patient showed remarkable improvement after the treatment. This therapeutic interventional case study revealed that Uttarabasti for eight sittings along with internal drugs provides significant relief in symptoms of urethral stricture.
Keywords: Gokshuradi guggulu, Mutrapraseka sankocha, Urethral stricture, Uttarabasti, Varunadi kwatha
|How to cite this article:|
Dwivedi AP, Mohapatra BK, Pathrikar A. Management of urethral stricture (Mutrapraseka sankocha) by Uttarabasti and oral medicines: A case report. J Ayurveda Case Rep 2023;6:23-6
|How to cite this URL:|
Dwivedi AP, Mohapatra BK, Pathrikar A. Management of urethral stricture (Mutrapraseka sankocha) by Uttarabasti and oral medicines: A case report. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:23-6. Available from: http://www.ayucare.org/text.asp?2023/6/1/23/372253
| Introduction|| |
Urethral stricture is a disease condition in which there is a narrowing of the urethra. Various causes of urethral stricture are inflammatory, congenital, traumatic, instrumental, and/or post-operative. The symptoms are usually related to bladder outflow obstruction such as poor urinary stream, retention, pain, burning micturition, suprapubic tenderness, thickening, and button-like feeling in the bulbar urethra. If a patient has gone into retention because of urethral stricture, its lumen will be too narrow to pass even a tiny catheter. In conventional medicine, the treatment includes urethral dilation and surgical methods such as external urethrotomy, internal urethrotomy, and urethroplasty are also employed with varied prognoses.
Acharya Sushruta has classified Mutraghata (~obstructive and suppressive uropathies) into eight types. As per the text, the etiological factors of Mutraghata mentioned are vitiation of Doshas (~humour), Aghata (~trauma), etc. The symptoms given are Sakashta (~straining), Sadaha (~burning), and Muhurmuhu mutra pravritti (~frequent micturition). In Ayurveda, the treatment of Mutrkricchra includes drugs such as Gokshura (Tribulus terrestris Linn.) and Varuna (Crataeva nurvala Buch-Ham.). Similarly, Sneha processed with the above drugs (~medicated oil or Ghee) should be administered in the form of Basti.
| Patient Information|| |
In the present case study, a male patient aged 24 years, presented to Shalya tantra OPD with chief complaints of straining during micturition, burning micturition, increased frequency of micturition, dribbling micturition, and unsatisfactory urination for four years. He visited to Ayurveda hospital with these complaints along with a report of a urethrogram (MCU RGU) dated September 4, 2017 showing mild stricture at bulbo-membranous junction with narrowing of the post urethra.
The patient was working in a private company. He had a history of obstructive Lower Urinary Tract Symptoms (LUTS). He was taking conventional medicines (Tablet Alfusin 10 mg [Alfuzosin], Gush powder [laxative], Capsule Providac [lactobacillus acidophilus and Bifidobacterium]) under the supervision of a urologist and some relief was noticed. He had no relevant family history and no surgical history. The patient was non-vegetarian, had a good appetite, a normal sleep pattern, and no addictions. Bowel habit was irregular with occasional constipation.
| Clinical Findings|| |
On general examination, the patient was hemodynamically stable having a pulse of 72/min, respiratory rate of 18/min, and blood pressure of 120/80mm of Hg. On general examination; pallor, icterus, clubbing, cyanosis, edema, and lymphadenopathy were absent. On local examination, prepuce, glans, and meatus were found normal without any deformity and the testis and epididymis were non-tender, no swelling, and no inguinal lymphadenopathy were found. On systematic examination, no abnormality was found in the respiratory, cardiovascular, and central nervous systems. Looking at the history of obstructive LUTS, the probable cause of urethral stricture here may be recurrent urinary tract infection followed by scaring.
| Timeline|| |
Details of the timeline are mentioned in [Table 1].
| Diagnostic Assessment|| |
It was done with the help of previous urethrogram reports and symptoms complaints by the patient.
| Therapeutic Interventions|| |
The patient was treated with Uttarabasti [combination of 10 ml of Tila taila + 3 ml of Saindhavadi taila (Rock salt, bark of Arka root, black pepper, bark of Chitraka, Bhringaraja, Haridra, Daruharidra, Murcchita sesame oil and water) +2 ml Yavakshara taila along with oral medications [Gokshuradi guggulu (500 mg) twice a day with luke warm water, Varunadi kwatha (30 ml) twice a day with an equal amount of water].,,,, Written informed consent was recorded after explaining the proposed treatment line. For the therapeutic evaluation, parameters such as straining during micturition, burning micturition, dribbling micturition, prolonged micturition, and frequency of micturition were assessed before, during, and after the completion of treatment [Table 2].
| The Standard Operative Procedure of Uttarabasti|| |
Purva karma (~Preoperative procedure)
Written consent from the patient was taken before the procedure. Emptying of the bladder before Uttarabasti was advocated. Further, Sthanika snehana (~local oleation) with Tila taila (~Sesame oil) and Sthanika swedana (~local sudation) with Dasamoola kwatha was given at Kati pradesha (~around the lumbar region). Blood pressure and pulse rate were monitored before the main procedure.
Pradhana karma (~Main operative procedure)
The patient was placed in the supine position and local antiseptic care was taken. The penis was held at a 60-degree angle. Lox 2% jelly (5ML) was pushed into the urethral opening to achieve lubrication and anesthesia. Under all aseptic precautions, a disposable 20 ml syringe was filled with 15 ml of the medicated oil [Tila taila (10 ml) + Saindhavadi taila (3 ml) + Yavakshara taila (2 ml)]. Thereafter, its nozzle was fixed to infant feeding tube no. 6 FR, and the tube was inserted gently into the external meatus, and oil was pushed slowly over a period of five min. Optimum care was taken to avoid the entry of air into the urethra. A penile clamp was applied below the neck of the glans to prevent immediate backflow and for oil to be retained inside. The patient was advised to rest in the same position for 15 min, and thereafter, the clamp was released.
Paschat karma (~Postoperative procedure)
Post-procedure, the blood pressure and pulse rate were measured. The patient was instructed not to pass urine at least for the next two hours. He was also advised to avoid undue straining during micturition. This procedure was repeated in the same manner daily for eight sittings. The patient was assessed for changes in the symptoms at regular intervals [Table 3].
| Follow-Up and Outcome|| |
On the first day, the symptoms were moderate to severe. However, on day four of treatment, symptoms such as burning micturition subsided from moderate to mild, dribbling micturition reduced from severe to moderate, straining during micturition reduced significantly from severe to moderate, prolonged micturition decreased from severe to moderate and frequency of micturition subsided significantly from severe to moderate after Uttarabasti.
Further, on the 8th day, the patient got complete relief from burning and dribbling micturition. Straining during micturition was not noticed by the patient after the completion of eight sittings of Uttarabasti. Considering the improvement, only oral medicine was continued for one month. The patient was assessed on the 15th and 30th days. Complete relief was observed by the end of 30th day [Table 3].
| Discussion|| |
The Basti (urinary bladder) is said to be Vata sthana of Apana vayu and responsible for the normal evacuation of urine, stool, flatus sperm, etc., as quoted in the classical text. As per the Ayurvedic concept, Mutrapraseka sankocha is due to the predominance of Vata and Kapha dosha, whereas Dushyas (~vitiated Dhatus) are Rasa (~circulatory fluid), Rakta (~blood), Mamsa (~muscle), and Sleshmadhara kala (~mucous membrane). As the act of micturition is under the control of Apana vayu, its vitiation manifests urinary defects. Due to the vitiation of Vata dosha, Chala (~unstable), Ruksha (~non-unctuousness), and Khara guna (~roughness), increase in Mutrapraseka resulting in Mutrapraseka sankocha. Hence, for the treatment of Mutrapraseka sankocha, Vata and Kapha should be pacified, which is done by different medicines that are used in the procedure called Uttarabasti.
Probable mode of action of therapy
Sthanika snehana (~Local oleation)
Sthanika snehana with Tila taila increases venous, lymphatic, and arterial blood flow to the muscle and skin. It increases fluid stagnation in tissue space, removal of waste products of metabolism, nutritive exchange between blood and cells, modulate autonomic response, activates the parasympathetic nervous, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue and improve sleep.
Sthanika swedana (~Local sudation)
Swedana provides significant relief in the symptoms of Daurbalyata, Daurgandhyata, Nindradhikya, Sandhi shoola, Aysena shvasa, Snigdha angata, Anga gaurava, Gatra sada, and Svedabadha, and in the symptoms of Srotodushti of Rasavaha srotasa and Svedavaha srotasa.
Uttarabasti (~Intra urethral douche)
Taila (~oil) like Tila taila (~sesame oil), Saindhavadi taila, Yavakshara taila (~alkaline oil) are the oils especially used in the procedure. Tila taila possesses Ushna (~hotness), Teekshna (~sharpness), Sukshma (~fineness), Sara (~mobility), Vikasi, Mridukara (~Softness), Lekhana (~scraping), Vata-kapha prashamaka (~Vata-kapha predominance), Krimighna, and Vranaropaka (~wound healing) quality. It softens the tissue, increases elasticity, penetrates up to deep tissue, heals, and promotes regeneration. Saindhavadi taila has Saindhava lavana (~Rock salt). It has Chedana (~excision), Bhedana (~incision), Marga visodhanakara, and Sharira avayava mridukara quality. Hence, it softens the fibrosed hypertrophied tissues and penetration of Tila taila (~sesame oil). The Saindhava lavana (~rock salt) acts as Anulomaka (~movement) of Dosha, Sandhanakara (~act of uniting), and ultimately Mutramarga vishodhana (~urethra cleaning) takes place., Yavakshara taila has Teekshna (~sharpness) and Vata-Kapha shamaka (~Vata kapha dominance) properties and helps the removal of blockage. It helps in the scraping of obstructing substances.,
Gokshuradi guggulu is a well-known Guggulu kalpa effective in urinary disorders such as Mutraghata. It has Rasayana (~rejuvenation), Balya (~strength promoter), Raktaprasadaka (~purification of the blood), Basti-shodhaka (~clear urinary bladder), Kledaghna (minimizes stickiness), Tridoshaghna (~balancing three humors), Shothaghna (~anti edematous) and Lekhana (~scraping) properties. For the removal of any blockage in micro as well as macrovessels, Lekhana property is useful. Thus, it helps in correcting Srotorodha (~obstruction of body channels) in Mootravhasrotas. Gokshuradi guggulu improves nourishment, maintains the effectiveness of Mootravahasrotas, and improves the resistance of kidney tissue against any adversity, thus helping in refurbishing and preventing damage to kidney vasculatures and tissues.,
Varunadi kwatha possess Tikta (~bitter), Kashya (~astringent) rasa, Ruksha guna (~non-unctuousness), Katu (~pungent) Vipaka (~taste at the end of digestion), and Ushna virya (~hot in potency) properties. It acts as Shothahara (~antiinflammatory) and Mutrala (~diuretic). The ingredients of Varunadi kwatha act as Chedana, Bhedana, Lekhana, Tridoshghna, Mutrakrucchrahara, Anulomana, and Krimighna, which helps significantly in LUTS treatment.,
| Conclusion|| |
The outcome of this case report revealed significant relief in the symptoms of urethral stricture such as burning micturition, straining during micturition, dribbling micturition, and unsatisfactory urination. This outcome infers that Uttarabasti along with oral Ayurveda drugs are effective in the management of Mutrapraseka sankocha and can avoid unnecessary surgical intervention. The outcomes may be specific to the present case and the usefulness of such modalities in other cases may be evaluated through well-designed studies.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]