E-ISSN:2456-3110

Case Report

Management of Urethral Stricture

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Role of Kshara Tail Uttarbasti in the management of Urethral Stricture - A Case Study

Mohan Meena H1, Mal Garhwal B2*, Shankar H3
DOI:10.21760/jaims.9.2.44

1 Hari Mohan Meena, Professor, Dept of Shalya Tantra, MMM Govt Ayurved College, Udaipur, Rajasthan India.

2* Bhagirath Mal Garhwal, Post Graduate Scholar, Dept of Shalya Tantra, Mmm Govt Ayurved College, Udaipur, Rajasthan, India.

3 Hari Shankar, Lecturer, Dept of Shalya Tantra, MMM Govt Ayurved College, Udaipur, Rajasthan, India.

Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturition. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas.

Keywords: Mutramarga Sankocha, stricture urethra, urethral dilatation, Uttarabasti

Corresponding Author How to Cite this Article To Browse
Bhagirath Mal Garhwal, Post Graduate Scholar, Dept of Shalya Tantra, Mmm Govt Ayurved College, Udaipur, Rajasthan, India.
Email: 		Mohan Meena H, Mal Garhwal B, Shankar H, Role of Kshara Tail Uttarbasti in the management of Urethral Stricture - A Case Study. J Ayu Int Med Sci. 2024;9(2):284-286.
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https://jaims.in/jaims/article/view/2910

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-09 2023-12-19 2023-12-29 2024-01-08 2024-01-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.79

© 2024by Mohan Meena H, Mal Garhwal B, Shankar Hand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Hari Mohan Meena et al. Kshara Tail Uttarbasti in the management of Urethral Stricture

Introduction

Urological issues are clearly a significant component of medical sciences even in those ancient times, as indicated by the study of the Sushruta Samhita[1], an ancient surgical treatise. That could be the reason why all of the classic texts provide a clear and stunning image of their classification, symptomatology, complications, and management. From the Atharva Veda, the oldest descriptions of urinary tract disorders may be traced. An in-depth explanation of Mutraghata and how it is treated with Loha Shalaka provides evidence that our ancestors were knowledgeable with the anatomical, physiological, pathological, and therapeutic aspects of the human body.

Mutravaha Srotas include Vrukka (kidney), Gavini (ureter), Mutrashaya (urinary bladder), and Mutramarga (urethra), according to Ayurvedic Sharira Rachana.[2] Ashtanga Hridaya defines that urination is the function of Vata, and its vitiation settles in disturbed urinary functions.[3,4]

In Ayurveda, urethral stricture is correlated with Mutra Marga Samkocha. Diseases of the genitourinary system are classified as Mutravaha Shrotas Vyadhi in Ayurveda. Acharya Shushruta categorized Mutraghata into twelve types. While Mutramarga Samkocha does not have an individual title, its symptoms are comparable to those of Mutrotsanga.[5] Acharya Shushruta has explained Uttarbasti as treatment procedure of Mutrotsanga. Acharya Charaka has classified urinary disease like Mutra Krichha into 8 types.[6]

Mutramarga Sankocha can be correlated with stricture urethra. Pathologically it becomes narrowed by a fibrotic tissue, which hampers excretion of urine. In modern science, the suggested treatment is urethral dilatation besides surgical treatment. It may cause bleeding, false passage and fistula formation. The surgical intervention like urethroplasty[7] also carries high grade risk of recurrences. Though the science has developed in many directions, it is unable to provide satisfactory treatment to patients without any complications and recurrences.

Seers highlighted the use of Uttarabasti in the management of Mutramarga Sankocha. Prior studies showed that Uttarabasti is a safe and effective symptomatic treatment

for urethral stricture. The current study demonstrates the effect of Uttarabasti of medicated Ksharataila in the management of urethral stricture.

Materials and Methods

Equipment required:

  • Surgical Gloves
  • 50 ml Autoclaved (Kshara Tail)
  • 50 ml Disposable Syringe
  • Kidney Tray
  • Infant Feeding Tube no.6
  • Betadine Solution
  • Sponge Holder
  • Honey 10 ml
  • Sterilized Gauze Pieces
  • 2% Lidocaine gel

Procedure

Uttar Basti is performed in following 3 phases as follow.

1. Purvakarma (pre-operative)

  • All the needed investigations are done and necessary vitals are taken at first.
  • Patient is asked to void urine, and be free from natural urges. Then asked to lie in supine position with cloth undone.
  • Then Antiseptic care is given.
  • Then luke warm autoclaved oil is mixed with rock salt.

2. Pradhan Karma (operative)

  • Thus, obtained mixture is loaded in 10 ml disposable syringe.
  • The penile region is painted by betadine with help of betadine soaked gauzes and sponge holder. Then penis is retracted and cleaned by betadine solution.
  • Then fetal feeding tube is inserted and when it reaches bulbomembranous urethra patient is asked to take deep breathe. Further fetal feeding tube is inserted till it reaches bladder.
  • Then the medicated oil

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Hari Mohan Meena et al. Kshara Tail Uttarbasti in the management of Urethral Stricture
  • mixture is passed through fetal feeding tube by the help of syringe in one shot. Patient is asked to remain in same position till 15 minutes.
  • Then the fetal feeding tube is removed and prepuce is repositioned to avoid phimosis. This process is done in continue for 7 days.

3. Paschat Karma (post operative)

  • Patient is avoided to micturate till 45-60 minutes after procedure.
  • Post procedure vitals are taken and noted.
  • Patient is called for follow-up on regular interval

Contraindication

  • Anatomical uretheral stricture
  • Phimosis
  • Hypospadias
  • Epispadias
  • Rupture of urethra
  • Urethritis

Observations and Results

Uttarbasti is more effective for treatment of uretheral stricture (Mutra Marga Sankocha). After 7 days of this procedure, it was observed that patient felt 50% decrease of symptoms and after 21 days of treatment report in RUG significant resolution of stricture was along with 90% decrease of symptoms.

SymptomsBefore TreatmentAfter Treatment
Painful Micturition+++-
Dribbling and prolongation of micturition++-
Obstructed Urine Flow+++
Straining++-
Strangury++++

Discussion

Mutramarga Sankocha is a clinical entity where in vitiation of Vata Dosha specifically of Apana Vayu, sheltered in the Basti and Medhra occurs. Hetu-Sevana results in Vikruti of Apana Vayu in consequence to this, Chala, Ruksha, Khara Guna increases resulting into Sansaktata of Mutramarga and hence the Mutramarga Sankocha. There is a synergistic action of Kshara Taila and action of the Uttarabasti

. Kshara Tail in the Taila form has the properties of the Lekhana and Ksharana. Therefore, it might be resulting into the Ksharana and Lekhana of Mutramarga Gata Sansaktata. The Ushna and Snigdha Guna of Tila Taila pacifies the increased Rukshatwa, Kharatwa and Chalatwa of Apana Vayu, restoring its normal function and thus brings about Stroto Shodhana and local Snehana actions.

The study drug is directly instilled into the urethra, a known Sthana of Vayu, which gives direct access to the seat of Srotovaigunya and Dosha Dushya Sammurchhana. This directly acts on the Vikruta Vayu and breaks the Samprapti.

References

1. Shastri AD. Sushruta Samhita: Ayurveda Tatva Sandipika, Nidansthanam, Uttar Tantra chapter, 58-59 sloka-Chaukhambha Sanskrit Sansthan, Varanashi. 2006.n; p-425; 432.

2. Shastri K. Charaka Samhita of agnivesh with vidyotani hindi commentary, vimansthan, chapter, 5 chaukhambha Sanskrit sansthan, Varanasi.p- 593.

3. Athavale BV. Delhi: Chaukhamba Sanskrit Prakashana; 2004. Urology in Ayuveda; p. 212.

4. Varanasi: Chaukhamba Sanskrita Santhan; 2007. Vagbhata, Asthanga Hridaya, Vidyotini Tika, Sutra Sthana 12/9; p. 90.

5. Varanasi: Chaukhamba Sanskrita Santhan; 2002. Sushruta, Sushruta Samhita, Ayurveda Tatvasandipika Hindi Commentary, Uttara Tantra 58/3-4; p. 423.

6. Varanasi: Chaukhamba Sanskrita Santhan; 2002. Sushruta, Sushruta Samhita, Ayurved Tatvasandipika Hindi Commentary, Uttar Tantra, 58/15-16; p. 425.

7. Al-Qudah HS, Santucci RA. Extended complications of urethroplasty. Int Braz J Urol. 2005;31:315–23.


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