uttarbasti in bph and its managment by modern

helpful for bph

1. Government Ayurvedic College & Hospital, Dharashiv . Shalyatantra Department RANDOMIZED CONTROLLED CLINICAL STUDY OF PALASHA SIDDHA TAILA UTTARBASTI IN URETHRAL STRICTURE W.S.R. TO MUTRAMARGSANKOCHA Guided by-
DR. SEEMA GIRI
DR. DHANA LILKE
DR. KASLE HOD
DR. DHANA LILKE Presented by –
DR. SONALI ASHOK FULSUNDER Shalyatantra PG Scholar

2. INTRODUCTION A Urethral Stricture is a narrowing of Urethral lumen by fibrotic tissue , which restricts urine flow from the bladder and produces LUTS like Hesitancy, Urgency, Dysuria etc. In Modern treatment includes Repeated instrumentation carries the risk of local trauma, false passage, infection, techniques are expensive & unsatisfactory Acharya Sushruta described Uttarbasti under the heading of Shashtiupakrama , which is a unique treatment of Mutraghata and Mutrakrichhra Vyadhi . So owing to this, study was carried out to evaluate the efficacy of Palasha Siddha Taila Uttarbasti in Urethral Stricture and the results are clinically satisfying.

3. AIMS & OBJECTIVE Aim: To evaluate the efficacy of Palasha Siddha Taila Uttarbasti in Urethral Stricture. Objectives: To Provide a Reliable & Economical therapeutic remedy for management of Urethral stricture. To avoid Urethral dilatation and surgery (DVIU and Urethroplasty ). To establish Evidence based Standard Ayurvedic remedy for management of Urethral stricture.

4. HYPOTHESIS Null Hypothesis – Palasha Siddha Taila Uttarbasti is not effective in Urethral stricture Alternative Hypothesis – Palasha Siddha Taila Uttarbasti is effective in Urethral Stricture

5. Materials & Methods Duration of Study -18 months Duration of treatment - 30 days Follow up - 0 , 15th and 30th day

6. SUBJECTIVE CRITERIA Weak Stream Dysuria Hesitancy OBJECTIVE CRITERIA Urine Flow(ml/sec) USG post -void volume of urine Pre Retrograde Urethrogram ASSESSMENT CRITERIA

7. Patients diagnosed as urethral stricture with mild to moderate symptoms Patients of both sex male and female. Patients of age group 15 to 60 years Patients irrespective of caste, religion, sex and economic status. Patient well diagnosed after clinical examination, Laboratorial & Radiological examination. Urinary tract infection Uncontrolled DM Neoplasm of Urinary tact Impacted calculus in urethra and bladder neck. Acute retention of urine. Patient suffering from any systemic disease e.g. Uncontrolled HTN, DM, Asthma, Koch’s, CVS disorder, Patient positive case of Infective Disorder, HIV, HbSAg Neurological Condition SELECTION OF STUDY SUBJECTS INCLUSIVE CRITERIA EXCLUSIVE CRITERIA

8. DRUG REVIEW Preparation of Palasha Siddha Taila कल्काच्चतुर्गुणीकृत्य घृतं वा तैलमेव वा । चतुर्गुणे द्रव्ये साध्यं तस्य मात्रा पलोन्मिता ।। -( शा.सं.म.खं.अ.९-१)

9. Preparation of Palasha Siddha Taila

10. Palasha Siddha Taila is having the main properties Vata- Kaphagna . Palasha dravya is Mutrala and also work as Lekhana dravya which causes Scrapping of the fibrosed lining of the Urethral Lumen, whereas Til Taila possesses Vyavahi , Sukshma & Snigdha (smooth) Guna which helps in the Lubrication, Dilatation . Palasha contains Gallic acid which is a Kshara (Alkali) which helps in Lekhana Karma. Now coming to the Mechanical effect of Uttarbasti as due to frequent insertion of an infant feeding tube in increasing sizes mechanically dilates the contracted part of Urethra . Results in no stasis of urine reduces chances of UTI & Ultimately results in less chance for recurrence of urethral stricture. MODE OF ACTION

11. OBSERVATION & RESULT A) Weak stream Table: Wilcoxon Signed Ranks Test: in Group A and in Group B Group Day N Mean SD W P Group A D0 30 2.633 0.49 137 < .00001 D30 30 0.867 0.628 Group B D0 30 2.633 0.49 137 < .00001 D30 30 1.33 0.479 Group Day N Mean SD W P Group A D0 30 2.367 0.490 137 < .00001 D30 30 0.6 0.563 Group B D0 30 2.5 0.572 126 < .00001 D30 30 1.133 0.434   B) Dysuria Table: Wilcoxon Signed Ranks Test: in Group A and in Group B

12. Group Day N Mean SD W P Group A D0 30 2.133 0.730 116 < .00001 D30 30 0.3 0.466 Group B D0 30 2.433 0.568 137 < .00001 D30 30 1 0.371 C) Hesitancy Table: Wilcoxon Signed Ranks Test: in Group A and in Group B

13. % Relief in Symptoms of both groups Sr. No. Symptoms   % Relief Group A Group B 1 Weak stream 67.09 49.37 2 Dysuria 74.65 54.67 3 Hesitancy 85.94 58.90 4 Avg. % Relief 75.89 54.31

14. % Change in Objective Parameters of both groups Sr. No. Parameter   % Change Group A Group B 1 Post Void Urine 80.56 63.54 2 Volume (ml/s) -165.81 -143.36 (- indicate increase)

15. STATISTICAL ANALYSIS Overall Effect of Therapy as per Statistical analysis Sr. No.   Parameters Within Groups (Wilcoxon test) Group A Group B 1 Weak stream Significant Significant 2 Dysuria Significant Significant 3 Hesitancy Significant Significant Sr. No. Objective Parameter Within Groups (Paired t test) Group A Group B 1 Post Void Urine Significant Significant 2 Volume (ml/s) Significant Significant

16. It was observed that both the groups i.e. Group A [Trial] ( Palasha Siddha Taila Uttarbasti ) and Group B [Control] ( Tila Taila + Saindhav ) got significant relief in the symptoms. According to the statistical data analysis, the P value was significant in cases of weak stream, dysuria, hesitancy and volume of urine in ml/sec, Post Void Urine which means that Group A is more Significant than Group B in the cases of urethral stricture. During the study time no recurrence rate was noted as it was a short duration study. Palasha Siddha Taila is having the main properties Vata- Kaphagna . Palasha dravya is Mutrala and also work as Lekhana dravya which causes Scrapping of the fibrosed lining of the Urethral Lumen, whereas Til Taila possesses Vyavahi , Sukshma & Snigdha (smooth) Guna which helps in the Lubrication, Dilatation . DISCUSSION

17. As P value is less than 0.05, it is proved that Palasha Siddha Taila Uttarbasti is effective in management of Uttarbasti . Hence Alternative Hypothesis is accepted. There are lesser evidence of Recurrence, less complications, Minimal invasive, economical & cost effective treatment than Modern Procedures CONCLUSION

18. C O N C L U S I O N

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