Unani concept of prostatic enlargement is described along with its management

1. Benign prostatic hypertrophy
Azm-e-Guda-e Mazi
Dr. MSM Shiffa
MD, BUMS, LLB, AAL

2. Definition
• Benign prostatic hypertrophy (BPH) is a
condition of unknown aetiology characterized
by an increase in size of the inner zone
(periurethral glands) of the prostate gland
Epidemiology
• Present in 50% of 60–90-year-old-men

3. Pathophysiology
• Microscopic stromal nodules develop around
the periurethral glands
• Glandular hyperplasia originates around these
nodules
• As the gland increases in size, it compresses
the urethra, leading to urinary tract
obstruction

4. Asbab
• Kasarat-e-mubasharat
• Excessive use of Sharab
• Effect of sardi and garmi
• Sitting on a hard surface for a long time

5. Aqsam
• Narm – soft
• Sakht - hard

6. Clinical features
Initially outlet obstruction:
• Weak stream, hesitancy, intermittency, dribbling,
straining to void, acute urinary retention
Subsequent detrusor instability:
• Frequency, urgency, nocturia, dysuria, urge
incontinence
Finally detrusor failure and chronic retention:
• Palpable (or percussible) bladder, overflow
incontinence
• Enlarged smooth prostate on digital rectal
examination

7. • Narrowing of urethra
• Hesitancy at the beginning
• Desire to urinate but unable to do so
• Dysuria
• Salasul bole (incontinence)
• Bole ud dam
• Ihtibas e bol
• Bad odour of urine
• Sleep disturbance

8. Investigations
• Basic investigations
• Urinalysis and urine culture for evidence of
infection or haematuria.
• FBC: infection.
• U+E and serum creatinine: renal function.
• PSA: suspicion of underlying malignancy.

9. Further investigations
• Voiding diary.
• Uroflowmetry and residual volume
measurement (normal <100 ml): evidence of
obstruction.
• Ultrasonography of kidneys and bladder:
structural abnormalities.
• Transrectal ultrasound: to determine prostate
size.
• IVU: structural abnormalities.
• Cystoscopy.

10. Complications (of surgical treatment)
• Postoperative haemorrhage and clot retention.
• UTI.
• Retrograde ejaculation, impotence.
• TURP syndrome: in 2% of patients absorption of
irrigation fluid via venous sinuses in the prostate
causes hyponatraemia, hypotension and
metabolic acidosis.
• Incontinence.
• Urethral stricture.

11. ESSENTIAL MANAGEMENT
Medical
• Alter oral fluid intake, reduce caffeine intake.
• α-Adrenergic blockers (e.g. phenoxybenzamine,
prazosin).
• Anti-androgens acting selectively at prostatic
cellular level (e.g. finasteride).
• Intermittent self-catheterization if detrusor
failure.
• Balloon dilatation and stenting of prostate (unfit
patient).

12. Surgical
• Majority of patients are treated surgically.
• Surgical removal of the adenomatous portion
of the prostate.
• TURP with electrocautery or laser.
• Thermal ablation of prostate.
• Open prostatectomy if large which may be
transvesical or retropubic.

13. Usool-e-ilaj
• Eliminate the cause
• Stop alcohol
• Reduce the kasarat e mubasharat
• Avoid extreme hotn and cold
• Mudir-e-bole
• Daf-e-tasannuj
• Muhallil
• Daf-e-tafoon
• Abzan
• Dalak
• Qabizat (cautious)

14. Ilaj
• Balooti 5 g with milk or water
• Jawarish-e-zarooni 5 -10 g
• Majoone dabeedul ward 5 g along 60 ml of
arq-e-mako
• Majoon-e-masikul bole

15. • Lunuwarana pothu kasaya 12 kalang
• Chandrabrabawati - P2 m & e
• Thripala choorna - 1 tsp m & e
• Vasti
– Narayana thaila : Dashamula kasaya = 1:5 or
Narayana alone
• Apply Dasanga lepa + siyambala kola

16. Thank you