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  1. 1. ROLE OF UTTAR BASTI IN THE MANAGEMENT OF MUTRA MARGA SANKOCH (URETHRAL STRICTURE). AMILKANTHIWAR RAJENDRA H. Department of Shalyatantra Government Ayurveda College, Osmanabad, Maharashtra, India. Email: drarajendrah@rediffmail.com Abstract (Urethral stricture). As far as conventional surgery is concerned urethral stricture still remains a challenge due to post procedural high recurrences and complications. Uttarbasti is per urethral administration of medicated oil, which has been recommended by Sushrut for such urinary track disorders. Objectives: To study the efficacy of Uttarbasti in the management of mutra marga sankoch (Urethral stricture). Material and method: Material: Drugs required: Til Tail (sesame oil), Saindhav lavan(Rock salt), Madhu(Honey). Equipments required for the administration of Uttarbasti. Drugs to prevent shock and tackle emergency. Method:
  2. 2. Inclusion criteria: well-diagnosed patients, after clinical and radiological assessment, of either sex and from all age groups are randomly selected. Exclusion criteria: Patients with acute UTI, DM, and neoplasm of lower urinary track, BEP, and impacted calculus in urethra and bladder neck. Five Uttarbasti were given to the patients at the interval of 7 days. Subjective and objective parameters were observed, graded and recorded at the first Uttarbasti and followed up after each. All the observations were analyzed by parametric and non-parametric statistical methods. Post procedural follow up taken, for not less than five years. Results: The results observed in this study revealed considerable difference in the symptomatology and in the radiological findings as well. Discussion and conclusion: Uttarbasti being almost non invasive, with considerably minimum recurrences and most economical, easy to practice OPD procedure, could be the treatment of choice in the management or urethral stricture. Keywords: Urethral stricture, Ayurvedic treatment, mutra marg sankoch, uttarbasti. Sesame oil, Honey, Rock salt. Introduction Acharya Sushrut – the father of surgery had mentioned excellent procedures for the management of many surgical disorders. Many herbal or mineral drugs are in use for several medical or surgical disorders since ancient times, particularly where modern line of treatment has limitations either in form of recurrences or complications. The information is passed down by the word of mouth from generation
  3. 3. to generation. To establish the effectiveness of these surgical and parasurgical procedures with full evidence, thorough scientific studies are required. Urethral stricture is a condition where modern surgical or parasurgical procedures pose many difficulties and complications. Acharya Sushrut and Charak had recommended uttarbasti for the management of many urinary tract disorders. Uttarbasti is – Per urethral administration of medicated oil or decoction Simple, non-invasive, OPD procedure. In an attempt to establish an effective therapy for urethral stricture of varying etiology the role of uttarbasti was studied in 210 patients and the results are presented in this communication. Material and method: Material: Drugs Til Tail (Sesame oil) Saindhav lavan (Rock salt) Madhu (Honey) Equipments Sterile 20ml glass syringe Sterile penile clamp Sterile cotton pad Drugs to prevent shock and tackle emergency Methods:
  4. 4. Inclusion criteria for patients: 210 randomly selected well-diagnosed male and female patients of all age groups. Exclusion criteria for patients: With acute urinary tract infection Diabetic patients With neoplasms of lower urinary tract With benign prostatic enlargement With impacted calculus in urethra and bladder neck. Parameters for grading of symptoms and relief of the patients: Symptoms of urethral stricture (mutra marga sankoch) present at first visit were graded and followed up after each uttarbasti as Severe Moderate Mild Complete relief Symptoms +++ ++ + - Table 1: Observations according to symptoms. Symptoms Total Severe Moderate Mild After 5th Uttarbasti After 5th Patients Uttarbasti No response to treatment Complete Slight
  5. 5. relief relief Burning 210 133 70 07 175 35 NIL micturition Frequency of 203 56 98 49 175 28 NIL micturition Straining at 210 175 35 - 189 21 NIL micturition Decreased 210 203 07 - 161 49 NIL stream Prolonged 210 21 161 28 196 14 NIL micturition Haematuria 42 - 14 28 42 - NIL Incontinence of 63 14 42 07 63 - NIL urine Stangury 168 42 126 - 161 07 NIL Retention of 07 07 - - 07 - NIL urine Investigations: Urethrogram Volumetric studies Routine blood and urine were done before and after treatment.
  6. 6. Procedure of uttarbasti: Pre procedure (Purvakarma): Investigations Written consent Emptying of bladder Monitoring BP and pulse Procedure (Pradhankarma): After proper preparation of the part and draping under all aseptic precautions, glass van is filled with 20ml of lukewarm mixture prepared. By holding the glans penis with the thumb and the index finger, nozzle of the syringe is inserted gently into the external urethral meatus and slight pressure is applied to fix the junction. The mixture is administered with slight pressure and slowly over a period of 30 seconds. Care is taken to avoid air entry into the urethra. Penile clamp is applied just proximal to glans penis and patient is kept in situ for 15mins. Female patients were advised to constrict urethral sphincter by tightly holding one leg over another. The procedure is repeated at an interval of seven days. Post procedure (Paschatkarma): Penile clamp is removed after 15mins. Monitoring of BP and pulse Patients were advised not to micturate for a couple of hours
  7. 7. Patients were advised to avoid undue straining and unsafe intercourse Procedure is repeated in the same way up to the complete relief of the symptoms. Profile of patients: Incidences of urethral stricture in relation with – Sex: More common in males (96.67%) and very less in females (03.33%). Age: Most common in sexually active persons. 96.67% cases were of age group between 16 and 45 years and least common in children (no case recorded). Table 2: Age profile Age Number of patients 00-15 years 00 (00.00%) 16-30 years 98 (46.67%) 31-45 years 105 (50.00%) 46-60 years 07 ( 03.33%) Marital status: 70% cases were married while 30% cases were unmarried Aetiological factors: 70% cases had history of exposure to unsafe sexual intercourse and urethritis was found as cause of stricture. The incidence was followed by instrumental cause which was 16.67% (Incidences shown in table 3). Sr. No. Aetiological factors No. of patients
  8. 8. 01 History of exposure (post 147 (70.00%) gonorrheal) 02 Instrumental (Indwelling 35 (16.67%) catheter) 03 Traumatic (Rupture urethra) 21 (10.00%) 04 Post surgery (Renal calculi) 14 (06.67%) 05 Meatal ulcer 07 (03.33%) 06 Post meatectomy 07 (03.33%) 07 Post circumcision 07 (03.33%) Prakruti: 83.33% cases were of vat-kapha prakruti and 16.66% of vata-pittaj prakruti Site of stricture: Membranous urethra – 119 (56.66%) Junctional urethra – anterior and posterior – 56 (26.66%) Prostratic part of urethra – 21 (10.00%) Penile urethra – 14 (06.66%) Recurrence: No recurrence was observed Number of uttarbasti for complete relief – Table 4: Number of uttarbasti required for complete relief
  9. 9. Number of uttarbasti Number of patients (%) 05 147 (70.00%) 07 56 (26.67%) 11 07 (03.33%) Results and Discussion: Effect of the subjective parameters has been shown in table 1. The age profile of the patients is shown in table 2. Results observed in this study are encouraging, which are 100% as noted at the end of maximum 11 uttarbasti (table 4). Pre and post procedural urethrography was carried out in all patients. Findings of urethrography revealed increase in the caliber of urethral lumen. Pre and post procedural urine flow rate was recorded. Pre procedural average urine flow rate was 30-50ml/10sec while after completion it improved to 140-160ml/10sec. No post procedural complications, delayed complications and adverse effects were observed. Probable mode of action of Uttarbasti: As per ayurveda- Til tail possesses ushna, teekshna, sukshma, sara, vikasi, mrudukara, lekhan, vat-kaph prashamak, krumighna and vranaropak qualities. It softens tissue, increases elasticity, penetrates up to deep tissue, heals and promotes regeneration. Saindhav lavan has chhedan, bhedan, margavishoshankara and shariravayav mrudukar qualities. So it softens the fibrosed hypertrophied tissue and also increases the penetration of til tail. The saindhav acts as sandhankar and anulomak for dosh and ultimately mutramarg vishodhan results.
  10. 10. Madhu possesses lekhan, vranashodhan, ropan, srotovishodhan, yogvahi, kshtkshayaghna property. It is synergistic to til tail and saindhav lavan. Thus the mixture acts as lekhan on local soft tissue and pacifies vat and kaph. By snehan it produces mardavata in tissues. Ultimately this results in not only healing and regeneration of urethral mucosa but increases the elasticity of the urethral and periurethral tissues as well. The mode of action of uttarbasti is irrespective of the site and the length of the stricture and the present study confirms the curative role of uttarbasti in urethral stricture (mutramarg sankoch). It shows better results as compare to present common techniques and could prove a blessing to the patients of urethral stricture (mutramarg sankoch). Acknowledgement: The author is grateful to late Dr. V.S. Amravat for his enthusiastic inspiration throughout the whole period of study he is also thankful to Dr. Sunil Kadam M.S. (Uro.), as without his guidance the work would have remained incomplete. References: Ayurvedic classic by sushrut-1000 B.C. chikitsasthana-ch-1/110.
  11. 11. Ayurvedic classic by charaka-400 A.C. siddhisthana-ch-9/64. Ayurvedic classic by Vagbhata-800 A.C. Sutrasthana ch-19/70 Ayurvedic classic by sushrut- 1000 B.C. sutrasthana-ch-45/132 1

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