A CASE REPORT–
AYURVEDIC MANAGEMENT OF MUTRAKRUCHHA ‘MUTROTSANG’ (URETHRAL STRICTURE)
Authors
*Dr. Aishwaryakumari Chaudhari,
**Dr. Harshil Padhiyar,
***Dr. Payal Babariya,
****Dr. Anamika Soni,
*****Dr. Hansraj Choudhary
*/**/***Second Year scholars, Post Graduate Department of Kayachikitsa, Government Akhandanand Ayurveda College Ahmedabad, Gujarat.
****Associate Professor, Upgraded Post Graduate Department of Kayachikitsa, Government Akhandanand Ayurveda College Ahmedabad, Gujarat.
*****Associate Professor, Department of Kayachikitsa, Government Ayurveda College Bikaner, Rajasthan.
Abstract
A Urethral stricture is a narrowing of the urethra, causing obstructive symptoms. It is usually result from injury to the urethral mucosa and tissue around it. Urethral stricture is relatively common disease in men with prevalence of 229-627 per 100000 males. There is no medical therapy to treat urethral stricture. Urethral dilation, urethroplasty, urethrotomy is the most practised approach for urethral stricture. Urethral strictures have high recurrence rates; incidence of urethral stricture recurrence ranges between 2% to 36.5% with 75% occurring within the first 6 months of the surgery. Urethral stricture surgery can have many complications including bleeding, infection, swelling, fever, urine incontinence, erectile problems, dyspareunia and urethra-cutaneous fistula. A 64 years old male patient presenting with symptoms of difficulty in passing urine, heaviness and distention of abdomen with retrograde urethrogram finding shows stricture urethra with bladder outlet obstruction, treated effectively and successfully with Uttar-Basti, kala-Basti and oral ayurvedic medicine. The assessment done before and after treatment shows significant changes in sign, symptoms and RGU report. No difficulty of passing urine was noticed in follow up visit.
Keywords: Mutrakruchha, Udavarta, Urethral Stricture, Uttar-Basti, Kala-Basti
Introduction
A urethral stricture is narrowing of urethra caused by scaring. the prevalence of urethral strictures in men is estimated to be 200 per 100,000 in younger men and more than 600 per 100,000 in men older than 65. In females, 2-29% of patients presenting with refractory lower urinary tract symptoms (LUTS) have bladder outflow obstruction (BOO) of whom 4-20% will have a urethral stricture. True FUS therefore occurs in 0.08-5.4% of women with refractory LUTS. Urethral stricture is less common in females because the urethra in the female is shorter than male. The male urethra is divided into 4 parts; Extends inferiorly from urinary bladder and ends prior to entering the prostate gland (pre-prostatic urethra), completely encompassed within the prostate gland (prostatic urethra), begins immediately outside of the prostate and ends just prior to entering the bulb of the penis (membranous urethra), travels the entire length of the penis via the corpus spongiosum (spongy urethra). Reaction to various extrinsic irritants can lead to complete replacement of the spongy tissue by scar tissue.
In ayurveda, difficulty in passing urine associated with pain is termed as a Mutrakruchha. Mutrakruchha is disease of Mutravaha Srotas. In Mutrakruchha, vitiated dosha separately or all together Basti and distress the urinary passage leads to difficulty in passing urine. Excessive physical exertion, intake of Tikshna medicines, habitual intake of alcohol made of Ruksha Dravya, riding on fast moving animals, over eating meat of marshy animals and fish, intake of food before previous meal is digested and Ajirna, these are the causative factors of Mutrakruchha.
Material and Methods
Patient information
A 64 years old male patient visited OPD No. 4, P.G. Dept of Kayachikitsa at Govt. Akhandanand Ayurved College & Hospital, Bhadra, Ahmedabad on date 18/07/2024 with following complains:
∆Kruchha-mutrata (difficulty in passing urine)
∆Udar Gauravata (heaviness of abdomen)
∆Udar Adhmana (distention of abdomen)
History of present illness
Patient was completely heathy before 3 years. 2.5 years ago patient was suffered from perineal abscess, he had taken allopathy treatment for it. After it patient suffered from difficulty in passing urine. patient was fed up with regular urethral dilatation, catheterization and recurrent urinary tract infection along with bloating etc. GIT disturbance so, for further treatment patient was visited Government Akhandanand Ayurveda Hospital, Ahmedabad.
Past history
Perineal abscess (2.5 years ago)
Catheterization and urethral dilatation every month (since 2 years)
K/C/O Hypertension (since 20 years)
Medicine history
Tab. Amlodipine – 1 OD
Personal history
Diet: Vegetarian
Sleep: 6-7 hours/night
Bowel movement: 2 time /day
Micturition: Catheterization (800-1000ml/day)
Vitals
Pulse-82/min
B. P. - 158/96 mmHg
Temperature- 98.6 F
Respiratory rate- 20/min
Samprapti
60+Age (Proudhavastha)
|
Perineal abscess
|
Prolonged and recurrent catheterisation
|
Local mucosal inflammation, ulceration healing with stricture
|
Urinary dilation
|
Mutrakruchha- ‘Mutrotsang’
|
Udavarta
Samprapti Ghatak
1. Dosha- Vata-Pitta pradhan tridosha
2. Dushya- Rasa, Rakta, Mamsa, Mutra
3. Srotas- Rasavaha, Raktavaha, Mamsavaha & Mutravaha
4. Srotodusti- Sanga, Vimarga-gaman
5. Roga marga- Marma-asthi-sandhi
6. Agni- Samagni
7. Samata- Niram
8. Adhisthana- Sharira
9. Aashay- Pakwashaya
10.Vyaktisthana- Mutramarga
11. Swabhava- Chirkari
12.Sadhyaaasadhyata- Krichchhra-Sadhya
Investigation
Before
(06/03/2024)
Retrograde urethrogram
Anterior urethra – irregular narrowing seen in proximal bulbar urethra suggestive of stricture.
Treatment
Patient was admitted in IPD
1. Shivakshar pachan churna 5 gm
Yava kshar 500 mg
Swarnamakshik Bhasma 125mg
Muktashukti Bhasma 500 mg
Dhatrilauha 500 mg (BD Before meal with Sukumar ghrit)
2. Tab. Shankhvati (2 BD after meal)
3. Tab. Punarnava Mandoor (2 BD after meal)
4. Sthanik Abhyanga with Dashmoola taila & Nadi Swedana (katitah ubhay janusandhi paryant)
5. Kala Basti
- Niruha Basti (450 ml) with
Dashmoola kwatha(100gm)
Manjisthadi kwatha (100)
Gokshur churna (50 gm)
Punarnava churna (25gm)
Guduchi churna (25gm)
Madhu (50 gm)
Saindhav (5gm)
Til taila (100ml)
Shatpushpa kalka(10gm)
- Anuvasan Basti (40 ml) with - Saindhavadi taila - 20ml
+ Dashmoola taila – 20ml
6. Uttar Basti (20 ml) with - Kshar taila - 10 ml
+ Dashmoola taila - 10 ml
Investigation
Retrograde urethrogram
After treatment
(13/08/24)
Smooth narrowing calibre in region of prostatic urethra with mild extravazation of contrast.
Results
After 27 days of the treatment Patient had Completely relief from Kruchha-mutrata, Udar gauravata and Udar adhman with guda and uttar basti regimen along with shaman therapy.
Discussion
In present case, patient had suffered from perineal abscess for which he was treated with allopathy medicines and prolonged & recurrent catheterisation as per requirement of the treatment protocol. The use of higher antibiotics and painkillers during the abscess treatment caused mucosal irritation & mucosal toxicity as a side & adverse effect. Additionally prolonged urethral catheterisation also damage the mucosal linning of urethra because of recurrent infection.
After removal of prolonged catheterisation UTI couldn’t be checked with antibiotic etc. drugs; because the overall abscess healing time consumed almost 2 months under the intense treatment. That ultimately affected the Vyadhikshamatva and gradually UTI progressed to urethral stricture because of recurrent manifestation, ulceration and stricture formation.
बस्तौ वाऽप्यथवा नाले मणौ वा यस्य देहिनः |
मूत्रं प्रवृत्तं सज्जेत सरक्तं वा प्रवाहतः ||
स्रवेच्छनैरल्पमल्पं सरुजं वाऽथ नीरुजम् |
विगुणानिलजो व्याधिः स मूत्रोत्सङ्गसञ्ज्ञितः ||
….तीक्ष्णौषध….नित्यद्रुतपृष्ठयानात्|
….अध्यशनादजीर्णात् स्युर्मूत्रकृच्छ्राणि नृणामिहाष्टौ||
पृथङ्मलाः स्वैः कुपिता निदानैः सर्वेऽथवा कोपमुपेत्य बस्तौ|
मूत्रस्य मार्गं परिपीडयन्ति यदा तदा मूत्रयतीह कृच्छ्रात्||
तीव्रा रुजो वङ्क्षणबस्तिमेढ्रे स्वल्पं मुहुर्मूत्रयतीह वातात्|
पीतं सरक्तं सरुजं सदाहं कृच्छ्रान्मुहुर्मूत्रयतीह पित्तात्||
बस्तेः सलिङ्गस्य गुरुत्वशोथौ मूत्रं सपिच्छं कफमूत्रकृच्छ्रे|
सर्वाणि रूपाणि तु सन्निपाताद्भवन्ति तत् कृच्छ्रतमं हि कृच्छ्रम्||
Perineal abscess surgery and its medication, ICU care, hospitalisation, recurrent UTI, mucosal/ hepatic/ gastric drug toxicity and formation of stricture etc. all conditions developed the severe Udavarta sign and symptoms in the patient such as Abdominal distention, Abdominal heaviness, flatulence and retention of urine etc.
Treatment was planned as per the principle of Udavarta Chikitsa, Deepan, Pachan, Anuloman, Srotoshodhan, Srotoprasadan, Dhatuposhan and Brimhan. Shivakshar pachan churna given for Pachan, Deepan and Anuloman alonge with Yavakshar for removal of sanga. In addition Swarnamakshik Bhasma, Muktasukti Bhasma & Dhatrilauha with Sukumar ghrita for Snehan, Dhatu poshan and Brimhan. Punarnava Mandoor was given after meal for its Mutral effect along with Srotoshodhan and Srotoprasadan. The use of Dashmoola & Manjistadi Niruha Basti along with Anuvasan Basti of Dashmoola taila & Saindhavadi tail as a Kalabasti krama for Srotoshodhan, Srotoprasadan and Vatanuloman. Uttarbasti with Kshar tail and Dashmoola taila helps in Mutramarga shodhan and prasadan along with above procedures Sthanik Abhyang and Swedan helps in Vatanuloman.
All the applied tratment plan executed in indoor patient department with strict hygenic & sterile measures. As the patient had good satva, good build, cooperative nature and moderate strength in the body; the applied treatment protocol worked very well as the root eradication treatment breaking the vicious cycle of pathogenesis (Samprapti Vighatan) absolutely as there is no treatment for urethral stricture in contemprory allopathy science but in ayurveda it can be cured successfully if patient is not suffering with life threatening disease or severely immune compromised.
Conclusion
Urethral stricture can be treated effectively and successfully with ayurvedic treatment protocol including Uttar Basti, Kala Basti and oral medicine. There is no chance of recurrence of urethral stricture afterward if patient follow the Dincharya, Rutucharya and Naimitic rasayan measures.
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Above case was treated in P.G. Department of Kayachikitsa, Govt. Akhandanand Ayurved College & Hospital, Ahmedabad, Gujarat, India. The original article was published in 'International Journal of Research & Analyticle reviews (IJRAAR).
Article link- http://www.ijrar.org/papers/
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Presented by-
Dr. Aishwaryakumari Chaudhari
P G Final year Scholar
P G Kayachikitsa Department
Government Akhandanand Ayurved College, Ahmedabad, Gujarat, India
E-mail- aishchaudhari1998@gmail.com
Guided by-
Prof. Surendra A. Soni
H.O.D.
P G Kayachikitsa Department
Government Akhandanand Ayurved College, Ahmedabad, Gujarat, India
E-mail- kayachikitsagau@gmail.com
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