Understanding of MUTARGHATA w.s.r to B.P.H

Understanding of B.P.H w.s.r to
MUTARGHATA
DR NEHARU MANDOLI
BAMS, MS, FRHS, D,Pharma
Surgeon, Proctologist
Assisstant professor
Dept of PG studies in Shalyatantra
Shri Kalabyraveshwara Swamy Ayurvedic Medical College and
Hospital, Vijayanagar, Bangalore 104

CONTENTS
Mutraghata
• Introduction
• Nirukti and definition
• Types
• Nidana
• Samanya samprapti
• Samprapti ghataka
• upadrava
• Chikitsa
B.P.H
• Definition
• Aetiopathology
• Pathogenesis
• Clinical presentation
• Examination
• investigations
• Management
• Complications
CORELATION

INTRODUCTION
• The term mootraghata comprises of two words viz. mootra and aghata,
which stands for low urine output either by retention, anuria or oliguria
• Generally mutraghata are 12 in number
• Considered as mutra apravritti
• Mutra vibhandhatva is main characteristic feature of mutraghata
• Acharya Sushruta and Charaka considered mutraghata as mutrasada and
mutravarodha related disorders but Acharya Vagbhata explained both
mutraghata and mutrakricchra under one heading.

• The BPH is an old age related disorder in men which involves the growth of
the prostatic gland, situated at the emergence of urethra i.e. the base of the
urinary bladder. The growth / neoplastic changes in the prostatic gland occur
due to the changes in the level of hormones especially androgens &
estrogens.

DEFINITION
मूत्राघातम् मूत्रावरोधम ्॥ सु उ ५८/१
Dalhana defines a clinical entity of mootravaha srotas where in the
Obstruction to the flow of urine is the pathognomic sign, but further states that
some experts ascribe the term Dushti to Aghata as mootrashukra,
mootrasada, ushna vata types are not characterized by mootravarodha.
मूत्राघातेन मूत्रम् शोष्यते पररहन्यते वा घट्ट॥ च चच २६/५५
According to Chakrapanidutta, a condition characterized by drying or retention
of urine is mootraghata .

मूत्राघाते तु ववबन्धो बलवान ् कृ च्छ्रत्वमल्पम् इतत॥ मा तन ३०
Acc to Vijayrakshita a condition with severe obstruction and difficulty in
micturition with reduced urine output is mootraghata.

NIDANA:
Acharyas have not mentioned general causative factors for mootraghata, but those
factors which are responsible for mootrakricchra can be taken into account.–
व्यायमततक्ष्णौषध रूक्षमद्यप्रसंग तनत्य द्रुत पॄष्टयानात्
आनुप मत््य अध्यसनात अजीणाात्॥ च चच २६/३२
• Ativyayama – excessive exercise
• Teekshna aushadha – drugs of strong potency
• Rukshamadya prasanga – excessive indulgence in dry alcohol
• Nityadrutaprishtayaanat – riding on the back of fast moving animals regularly
• Anupamatsya – ingestion of flesh of wet land creatures
• Adhyashana – eating before digestion of previous meal
• Ajeerna – indigestion.

In addition to the above factors, the aetiology of mootravahasrotodushti is
also to be taken into consideration, which is described by Acharya Charaka
मूत्रत्रतोदकभक्ष्य्त्रीसेवनान्मूत्रतनग्रहात्।
मूत्रवाहहतन दुष्यन्न्त क्षीण्याभभक्षत्य च ॥ च वव ५/२०
• Mootratodaka bhakshya – excessive water intake with suppression of
mootra vega
• Stree sevanat – indulging in sex
• Mootranigrahat – suppression of the urge of micturition
• Ksheena – emaciated person

SAMANYA SAMPRAPTI:
सवेषु मूत्राघातेषु यतो वात: कारणम्॥ डल्हण सु उ ५८/२६
Acharya Dalhana quotes that Vata is the main factor in the pathogenesis of
mootraghata
मारुते प्रगुणे ब्तौ मुत्रं सम्यक् प्रवताते।
ववकारा ववववधाश्चावप प्रततलोमो भवन्न्त हह॥
मूत्राघातााः........................ सु तन ३/२७-२८
Acharya Sushruta states the importance of pratiloma vata in the basti-rogas
such as mootraghata, prameha, shukra dosha and mootradosha

Acharya Vagbhata states –
अधोमुखोऽवप बन््तहहा मूत्रवाहहभसरामुखाः।
पाश्वैभ्याः पूयातो सुक्ष्माः ्यन्दमाननारताम्॥
य्तेरेव प्रववश्येनं दोषााः कु वान्न्त ववंशततम्।
मूत्राघातान ् ..... अ हॄ तन ९/२-३
The commentator Arunadatta raises a doubt that, if basti were to be facing
downwards with a single outlet, then how does the doshas enter to, minute
vessels fill the bladder from the sides and these are the routes for the entry of
doshas, leading to mootraghata.

SAMPRAAPTI GHATAKA:
Dosha – Vaata (Apaana) pradhana Tridosha
Dooshya – Rasa, Kleda, Sweda, Mootra
Agni – Jatharaagnimaandya & Dhaatavaagnimaandya
Udbhava Sthaana -Pakvaashayasmuttha
Sanchara sthaana:
Adhishtaana – Basti
Vyakti Sthaana – Basti (Basti Shira)
Srotasa – Mootravaha
Srotodushti Prakaara – Sanga, Vimaargagamana, Sira granthi
Roga Maarga – Madhyama
Sadhyasahyata: krichrasadhya

TYPES OF
MOOTRAGHATA
SUSHRUTA
(S.U.58/34)
CHARAKA
(C.S 9/25-26)
VAGBHATA
(A. H.N. 9/2-3)
MADHAVAKARA
M.N.( 1/505)
B.P.
1) Vatakundalika  + + + +
2) Ashthila  + + + + +
3) Vatabasti  + + + + +
4) Mootrajathara  + + + + +
5) Mootrasanga  + + + + +
6) Mootrakshaya  + + + + +
7) Mootragranthi  + + + + +
8) Mootrashukra  + + + + +
9) Ushnavata  + + + + +
10) Mootroukasada
(pittaja)
 + + + + +
11) Mootroukasada
(kaphaja)
 + + + + +
12) Mootratita  + - - - +

1. VATA KUNDALIKA:
रौक्ष्याद्वेगववघाताद्वा वायुरन्तरमाचिताः।
मूत्रं चरतत संगृह्य ववगुणाः कु ण्ड्भलकृ ताः॥
सृजेदल्पाल्पमथवा सरुज्कं शनाः शनाः।
वातकु ण्डडभलकां तं तु व्याचधं ववद्यत ् सदारुणम्॥ सु उ ५८/५-६
Nidana:
 Ingestion of un-unctuous substance
 Suppression of the natural urges

Samprapti:
Pratiloma gati of vata into basti and form kundalakruti of basti
(Divarticla)
Lakshana:
 Scanty and dribbling micturition with increased frequency
 Painful micturition
 Rigidity, breaking pain, heaviness, girdle pain
 Severe colic
 Retention of feaces & urine

2. ASTHEELA :
शकृ न्मागा्य ब्तेश्च वायुरन्तरमाचिताः।
अष्टीलावद्घनं ग्रन्न्थं करोत्यचलमुन्नतम्॥
ववण्डमुत्रातनलसङ्गश्च तत्राध्मानं च जायते।
वेदना च परा ब्तौ वताष्टीलेतत तां ववदुाः॥ सु उ५८/८
Nidana:
वायुरन्तरमाचिताः i.e. Vitiated (Apaana)vata.
Samprapti:
शकृ न्मागा्य ब्तेश्च अष्टीलावद्घनं ग्रन्न्थं i.e.
the vitiated Vata gets lodged between the bladder and rectum and
produces the stony hard swelling.

Lakshana:
अचल उन्नत ग्रन्न्थ (ककन्न्चत ् चल) (singly movable and elevated)
ववण्डमुत्रातनलसङ्ग (retention of urine, faeces and flatus)
बन््तरध्मान (distention of the urinary bladder)
वेदना च परा ब्तौ (pain in the suprapubic region)

3. VATABASTI:
वेगं ववधारयेद्य्तु मूत्र्याकु शलो नराः।
तनरूणन्ध्दं मुखं त्य ब्तेबान््तगतोऽतनलाः॥
मूत्रसङ्गो भवेत्तेन बन््तकु क्षक्षतनवपडडत:।
वातबन््ताः स ववझ्नेयो व्याचधाः कृ च्छ्रप्रसाधन:॥ सु उ ५८/९-१०
Nidana:
 वेगं ववधारयेद्य्तु मूत्र्या (Suppression of the urge of micturition).
Samprapti: तनरूणन्ध्दं मुखं त्य ब्तेबान््तगतोऽतनलाः
the vata gets provoked owing to suppression of its action and causes obstruction
to the bladder outlet.

Lakshana:
मूत्रसङ्ग(retention of urine)
बन््तकु क्षक्षतनवपडडत(pain in bladder and loin region)
 तीव्र वेदना(itching sensation and severe pain in the bladder
region by Acharya Charaka)

4. MOOTRATEETA:
वेगं सन्धाया मूत्र्ययो भूयाः स्रष्टुभमच्छ्छतत।
त्य नाभ्येतत यहद वा कथन्चचत्सम्प्रवताते।।
प्रवाहतो मन्दरूजमल्पमल्पं पुनाः पुनाः।
मुत्रातीतं तु तं ववद्यान्मुत्रवेगववघातजम्॥ सु उ ५८/११-१२
Nidana: वेगं सन्धाया मूत्र्य (Suppression of the natural urge of micturition).

• Lakshana:
• यो भूयाः स्रष्टुभमच्छ्छतत त्य नाभ्येतत यहद वा कथन्चचत्सम्प्रवताते-
hegitency
•प्रवाहतो मन्दरूज( weak stream with mild pain)
•प्रवाहतो अल्पमल्पं(Obstructed flow with little quantity)
•प्रवाहतो पुनाः पुनाः(Increased frequency)

5. MOOTRAJATHARA:
मूत्र्य ववहहते वेगे तदुदवताहेतुना।
अपानाः कु वपतो वायुरुदरं पूरयेद्भृशम ्॥
नाभेरध्ताध्मानं जनयेत्तीव्रवेदनम ्।
तं मुत्रजठरं ववद्यादधाः स्रोतोतनरोधनम॥ सु उ ५८/१३-१४
Nidana:
मूत्र्य ववहहते वेगे (voluntary suppression of the desire of micturition)

Samprapti:
अपानाः कु वपतो वायुरुदरं पूरयेद्भृशम् i.e. in consequence of suppression of the
urge of urination, the vayu especially apana vayu gets aggravated and causes
painful distention of abdomen
Lakshana:
 नाभेरध्ताध्मानं जनयेत्तीव्रवेदनम्(Distension below the umbilical level
resulting into indefinite pain accompanied by retention of urine and feces).
 अपन्तत(indigestion) Ch. Si. 9/29-30; 719 & A.Hr. Ni.9/27,26; 367

6. MOOTROTSANGA :
ब्तौ वाऽप्यथवा नाले मणौ वा य्य देहहन:।
मूत्रं प्रवृत्तं सज्जेत सरततं वा प्रवाहताः॥
स्रवेच्छ्छनरल्पमल्पं सरूजं वाऽथनीरूजम्।
ववगुणातनलजो व्याचधाः स मूत्रोत्सङ्गसंन्जत:॥ सु उ५८/२५-२६
Nidana:
ववगुणा(Vitiated vata)
स्रवगुण्डयातनलाक्षेप(Abnormality of the urinary outlet)

Samprapti:
ब्तौ वाऽप्यथवा नाले मणौ वा य्य देहहन: i.e. In consequence of the nidana,
the urinary flow is obstructed at the level of either basti (i.e. BOO) or nala
(i.e.Urethral stricture) or mani ( pin hole meatus).
Lakshana:
मूत्रं प्रवृत्तं सज्जेत(Obstructed flow of urine)
सरततं (haematuria / obstructed)
वा प्रवाहताः (Straining / Hesitancy)
स्रवेच्छ्छनरल्पमल्पं (Intermittent flow)
सरूजं वाऽथनीरूजम्(voiding with or without pain)
ववन्च्छ्छन्नमूत्रच्छ्छेषगुरुशोफसाः(Dribbling of urine & feeling of heaviness in urethra)

7. MOOTRAKSHAYA :
रूक्ष्य तलन्तदेह्य बन््त्थौ वपत्तमारूतौ।
सदाहवेदनं कृ च्छ्रं कु याातां मूत्रसंक्षयम ्॥ सु उ ५८/१७
Nidana:
 रूक्ष्य तलन्तदेह्य
Samprapti: बन््त्थौ वपत्तमारूतौ कु याातां मूत्रसंक्षयम्
 i.e. even though a ruksha person has no pitta aggravating factors, but still
the involvement of the pitta along with vata has been stressed upon. This leads
to the drying up of the urine (mootrashoshana).

Lakshana:
सदाह (Burning micturition)
सवेदनं(Painful micturition)
मूत्रकृ च्छ्र ( Dysurea along with small quantity of urine)
Charaka has not given the involvement of pitta in this condition. The definition
given by Chakrapani i.e. “Pratihanyate shoshyate vaa” seems to be applicable
here and it could well define as a case of anuria. Hence, description of anuria is
presented here.

8. MOOTRAGRANTHI :
अभ्यन्तरे बन््तमुखे वृत्तोऽल्पाः न््थर एव च॥
वेदनावानतत सदा मूत्रमागातनरोधनाः।
जायते सहसा य्य ग्रन्न्थरश्मररलक्षणाः॥
स मूत्रग्रन्न्थररत्येवमुच्छ्यते वेदनाहदभभाः। सु उ ५८/१८-१९
Nidana:
रततं वातकफादखे दुष्टं(rakta vitiated by vata and kapha)

Samprapti:
अभ्यन्तरे बन््तमुखे सदा मूत्रमागातनरोधनाः जायते सहसा य्य ग्रन्न्थ
I.e. abrupt or sudden manifestation of the granthi in the interior side of the bladder
which obstructs the flow of urine is called mootragranthi or raktagranthi. Here,
rakta, vata and kapha get vitiated and are responsible for onset of raktagranthi as
per Charaka.
Sushruta didn‟t mention the doshika involvement but Dalhana specifies that
rakta is responsible factor in the manifestation of mootragranthi.

Lakshana:
 वृत्तोऽल्पाः न््थर ग्रन्न्थ A round, small and immobile granthi in the inner
side of the bladder. (Dalhana clarifies “Aabhyantare bastimookhe” as
“Bastidwarasyaabhyantare iti”)
 वेदनावानतत (Continuous pain)
 मूत्रमागातनरोधनाः (Retention of urine)
 कृ च्छ्रेण सृजेन्मूत्रं (Urine passed with difficulty and pain)
Ch. Si. 9/41; 719 & A. Hr. Ni. 9/31; 367

9. MOOTRASHUKRA :
प्रत्युपन््थतमूत्र्तु मथुनं यो ऽभभनन्दतत।
त्य मूत्रयुतं रेताः सहसा संप्रवताते॥
पुर्ताद्वाऽवप मूत्र्य पश्चाद्वाऽवप कदाचन।
भ्मोदकप्रतीकाशं मूत्रशुक्रं तदुच्छ्यते॥ सु उ ५८/२१
Nidana:
प्रत्युपन््थतमूत्र्तु मथुनं यो ऽभभनन्दतत i.e. performing coitus in the
presence of natural urge of micturition.
Samprapti:
त्य मूत्रयुतं रेताः सहसा संप्रवताते

Lakshana:
• पुर्ताद्वाऽवप मूत्र्य पश्चाद्वाऽवप
• भ्मोदकप्रतीकाशं मूत्र
Due to afore said nidana, the seminal fluid ejected by vata will be either
preceded or follow the urine stream, which is similar to bhasmodaka (ash
colored). This seems to be the physiological disturbance of the sphincteric
mechanism.

10. USHNAVATA :
व्यायामाध्वातपाः पत्त बन््तं प्राप्यातनलावृतम्।
बन््तं मेढ्रं गुदं चव प्रदहन ् स्रावयेदध:॥
मूत्रं हररद्रमथवा सरततं रततमेव वा।
कृ च्छ्रात ् प्रवताते जन्तोरूष्णवातं वदन्न्त तम्॥ सु उ ५८/२२-२३
Nidana:
अततव्यायाम(Excessive exercise)
अतत अध्वगमन (Excessive walking)
अतत आतपसेवन(Wandering/sitting in sunlight)

Samprapti:
वपत्तं बन््तं प्राप्यातनलावृतम्
बन््तं मेढ्रं गुदं चव प्रदहन ् स्रावयेदध:॥
Because of indulgence in causative factors, vata accompanied with pitta enters
basti and causes burning pain in the basti, medhra and guda and the person passes
urine with difficulty.
Lakshana:
हररद्र मूत्रता (Haridra – dark yellowish colored urine)
रतत मूत्रता(With blood or red colored urine – microscopic haematuria)
रततमेव(Only blood – heamaturia)
कृ च्छ्रात ् प्रवताते(Difficulty in micturition & flow)

11.Pittaja MOOTRAUKASADA:
ववशदं पीतकं मूत्रं सदाहं बहुलं तथा।
शुष्कं भवतत यच्छ्चावप रोचनाचूणा सन्न्नभम्॥
मूत्रौकसादं तं ववद्यद्रोगं वपत्तकृ तं बुध:॥ सु उ ५८/२४-२५
Nidana and Samprapti:
Pitta along with vata enter into the bladder and produce mootraukasada.

Lakshana
ववशदं(Turbid urine)
पीतकं (Yellowish urine)
सदाहं (Burning micturition)
बहुलं(Large quantity of urine with ↑ Specific Gravity of urine)
शुष्कं भवतत यच्छ्चावप रोचनाचूणा सन्न्नभम्(On Drying Color i.e. Gall Stone
of Cow)

12. Kaphaja MOOTRAUKASADA:
वपन्च्छ्छलं संहतं श्वेतं तथा कृ च्छ्रप्रवताम्।
शुष्कं भवतत यच्छ्चावप शङ्खचूणाप्रपण्डडूरम्॥
मूत्रौकसादं तं ववद्यादामयं द्वादशं कफात्॥ सु उ ५८/२५
Nidana and Samprapti:
kapha combined with vata enter into the bladder and produce mootraukasada.

Kaphaja variety:
वपन्च्छ्छलं मूत्र (Greasy & transparent appearance )
संहतं मूत्र (Cloudy urine with ↑ specific gravity of urine )
श्वेतं (Whitish urine)
कृ च्छ्रप्रवताम्(Difficulty in micturition & Stream)
शुष्कं भवतत यच्छ्चावप शङ्खचूणाप्रपण्डडूरम् (On drying up color
of urine is like Conch)

13. VIDVIGHATA :
रूक्षदुबालयोवाातेनोदावृत्तं शकृ द्यदा॥
मूत्रस्रोताः प्रपद्येत् ववट्संसृष्टं तदा नराः।
वव्गन्ध मूत्रयेत ् कृ च्छ्राद्ववघातं नराः॥ च भस ९/४२-४३
Nidana:
रूक्ष दुबाल- Person who is emaciated & dried out.
Samprapti:
वातेनोदावृत्तं शकृ द्यदा मूत्रस्रोताः प्रपद्येत ् ववट्संसृष्टं तदा नराः
i.e., the morbid vata enters into the urinary passage along with feces and
produces a condition characterized by foul smelling urine mixed with stools.

Lakshana:
Vagbhatta makes use of the terms – मूत्रस्रोतो ऽनुपयेतत instead of मूत्रस्रोताः
प्रपद्येत ् of Charaka . The condition very aptly describes the entities where in
faeces is passed through urethra.

Faeces Passed Through Urethra: - Feces or fecal fluid are passed per urethra
when the bladder is having fistulous communication with some part of the
bowel or with an abscess infected with E. Coli. Pneumaturia may occur at the
same time.
The chief causes are as below- Diverticular disease of the sigmoid colon and
fistula with bladder (Recto vesical
Fistula).
Prostatitis or prostatic abscess opening into the bladder.
Carcinoma of the bladder, sigmoid colon, uterus opening into the bladder.
Crohn‟s disease of large or small bowel with vesicle fistula.
The passage of faeces into urine may be occurred by some cases of very foetid
Cystitis due to infection of E. coli, especially in diabetic patients.

CHIKITSA OF MOOTRAGHATA:
There is very clear line of the management advocated by various
acharyas and all the aspects of “antahparimarjana” and “bahirparimarjana”
are integrated for treating mootraghata. The approach towards the treatment
of disease is completed initially from nidana parivarjana to pathya-apathya.
The common chikitsa sutra under the caption of mootraghata.

According to Sushruta –
कषायकल्पसवपिंवषभक्ष्यान ् लेहान ् पयांभस च॥
क्षारमद्या(ध्वा)सव्वेदान् ब्तींश्चोत्तरसंन्जतान्।
ववदध्यान्मततमां्तत्र ववचधं चाश्मररनाशनम ्॥ सु उ ५८/२७-२८
Drugs in the form of kashaya, kalka, sarpi, bhakshya, avleha, payas,
kshara, madya, asava, swedana, basti, uttara basti and formulations told in
context of ashmari disease are useful for managing mootraghata.

दोषचधतयमवक्ष्यतान् मूत्रकृ च्छ्रहरजायेत।
बन््तमुत्तरबन््तं च सवेषामेव दापयेत ्॥ च भस ९/४९-५०
The measures adopted for mootrakrichchhra are to be followed by basti and
uttara basti is to be administered in all the varieties of mootraghata. The
measure told for mootrakrichchhra are – abhyanga, niruha basti, snehapana,
uttara basti, seka, pradeha, virechana, kshara, takra, tikta aushadhasiddha
taila are advised for the individual doshas respectively.

THE DIFFERENT YOGAS for MOOTRAGHATA:
• Swarasa – Nidigdhikadi (BP & Su), Amalaka (Su), Kantakari (AS & AH)
• Kalka – Moostadi (Su), Abhayadi (Su), Draksha (Su & AS , Sasaindhava
triphala (AS), Pasanabedadi (AH), Kaandekshurakamoola (AS), Gokshura
(Sha & BP ) Vasa (BP) etc.
• Kwath – Devadarvyadi (AH), Shatavaryadi (Ch), Haritakyadi (AS & Sha.),
Trinapanchamoolaadi (AS & BP),

 Choorna – Vyoshadi, Ela, Pravala, Pashanabhedadi (Ch), Pippalee, Surasa,
Bibheetaka (AS), Hingvaadi choorna (Sha), Chandana (BP);
Usheeradi choorna (YR).
 Vati / Gutika – Chandraprabha vati, Gokshuradi Guggulu (Sha).
 Ksheerapaka – Kakolyadi, Trikantakadi (BP & YR).
 Sneha( Ghrita) Kalpana – , Bala ghrita, Mahabala ghrita, (Su);
Pashanabhedadi ghrita, Shwadanstra ghrita, Sthiraadi ghrita, (Ch);
Dashamooladi ghrita, Tilvaka ghrita (AS); Changeri ghrita, Dhaturadi
taila, Tilvaka ghrita (Sha); Vidaari ghirta, , Dhanyaka-gokshura Ghrita (BP).

 Kshara – Patala, Patalyadi (Su, BP, AS, AH).
 Avaleha – Swaguptaadi (BP).
 Panayoga – Punarnavadi (Ch)
 Sandhana Kalpana – Suraa (Su), , Madhukasava (Ch),
Tilaadi kshara yukta sura (AS).
 Upanaha – Punarnavadi (Ch).
 Yavagu – Saptachchhadadi (Ch) Gokshurakantakari Siddha (AS).
 Basti – Dashamooladi taila, Bilwadi, Shatavaryadi (AS), Vasottara (Su).

PATHYA IN MOOTRAGHATA:- BHAISHAJYA RATNAVALI
 Abhyanjana, sweda, virechana, basti, avagaha-sweda, uttara basti,
 lohitashali, purana mamsa, madya made by dhanva, takra,
mashyusha, purana kushamand phala, patola, ervaru, kharjura,
narikela, mastak of tala phala, purana shali, yava, etc. are all pathya to
the patients of Mootraghata.
 hence the food articles of above advised, will definitely be beneficial
in alleviating the symptomatology of mootraghata, at least to a certain
extent and mostly that of vata vitiation.

APATHYA IN MOOTRAAGHAATA:-
• Virudha anna, ahara which are ruksha, vidahee, vishtambhi & vyavayee,
• Vegadharana,
• karira,
• vamana, mootravegavarodha etc.
Are apathya as they all lead to vitiation of vata and results in further
deterioration of the condition of aghata or urine retention as well as
obstruction in flow of urine.

INTRODUCTION:
• It is enlargement of prostate which occurs after 50 years, usually
between 60 and 70 years.

AETIOPATHOGENESIS:
There are two theories to explain BPH
1. Harmonal theory:
with the age testosterone drops slowly but fall of estrogen level is not
equal, So prostate enlarges through intermediate peptide growth factor.
2. Neoplastic theory: there is proliferation of all the elements of prostate
like fibrous, muscular, and glandular resulting in fibromyoedinoma.

PATHOLOGY:
1. Urethra get compressed and gets converted in to a narrow, longitudinal
slit commonly in median lobe enlargement.
2. Bladder initially from trabeculations and sacculations later formation of
diverticula.
3. Kidneys and Ureter leading to hydronrphrosis and hydroureterosis
4. Infection- acute and chronic pyelonephrosis
5. Severe obstruction leading to renal failure
6. impotency

Clinical presentation:
Clinical traid
HEGISTANCY
FREQUENCY
URGENCY

1. Frequency- cystitis (fever, chills, burning micturition)
2. Urgency hesitancy and nocturia
3. Over flow and terminal dribbling
4. Haematuria
5. Acute retention of urine
6. Pain at suprapubic region in cystitis and at loin in hydronephrosis

ON EXAMINATION:
Per rectal examination: Enlargement of hard prostate is felt on pulp of
examiner finger specially lateral lobes.

DEFERENTIAL DIAGNOSIS:
• Stricture urethra.
• Bladder tumour, carcinoma prostate.
• Neurological causes of retention of urine like diabetes, tabes,
disseminated sclerosis, Parkinson’s disease.
• Idiopathic detrusor activity.
• Bladder neck stenosis; bladder neck hypertrophy.

Investigations
1. Urine: microscopy and culture – sensitivity
2. Blood: urea and creatinine
3. PSA
4. Acid phosphatase:
5. Serum electrolytes

6. Urodynamic study: pear flow rate
normally 20ml/sec
doubtful 10-15ml
deprite observation- <10ml
7. IVP/IVU- to see kidney function
8. Cystoscopy
9. Trans rectal scan: if nodular or Ca prostate
not advised routinely

10. USG pelvis: to assess - size weight of the prostate
- residual urine
-hydronephrosis
-diverticula

MANAGEMENT:
Medical:
• Residual urine <15ml
• Uroflowmetry >15ml/sec urine flow
1. Catheterisation: acute retension of urine
2. Finasteride acetate 5mg/day for 6 months
3. Beta adrenagic blocker: to relax internal sphincure
4. Aviod heavy alcohol consumption as ai may lead to prostatic
congetion and acute retension of urine.

5. To avoid overcdistension of bladder
6. Prompt correct electrolyte imbalance

SURGICAL MANAGEMENT:
Indication:
1. Prostatism- frequency, dysuria, urgency
2. Acute retension of urine
3. Chronic retension with residual urine >200ml
4. Complications like
Haematuria due to congestion of prostatic venous plexus
Hydroureteronephrosis, reccrent UTI
Calculi formation and Prostatic diverticulosis

SURGICAL METHODS:
1. TURP( trans urethral resection of prostate):
Popularly used method
I. Pre op instructions:
Npo
II. Operative procedure:
• Using cystoscope with fluid like glycine irrigating continuously,
• Enlarged prostate is identified and resected using a loop with a hand control.
• Resection is done using high frequency diathermy current, above the level of
verumontanum.

III. Post op instructions:
Antibiotics
Bladder irrigation with normal saline
Three way folley’s catheterisation
Catheter can be removed after 72 hours
Advantages :
1. Post op recovery is smooth and rapid
2. Post op in continence is rare

Postoperative complications are:
• TURP syndrome: Water intoxication with congestive cardiac failure
• Hyponatraemia
• Haemorrhage
• Infection
• Incontinence
• Perforation of the bladder or prostatic capsule
• Stricture urethra
• Retrograde ejaculation and impotence
• Recurrence.

2. TRANS VESCICAL PROSTATECTOMY:
• The bladder is opened, and the prostate enucleated by putting a finger into the
urethra, pushing forwards towards the pubes to separate the lateral lobes, and
then working the finger between the adenoma and the false capsule.
• In Freyer’s operation (1901), the bladder was left open widely and drained
by a suprapubic tube with a 16-mm lumen in order to allow free drainage of
blood and urine.
• Harris (1934) advocated control of the prostatic arteries by lateral stitches
inserted with his boomerang needle, the bladder wall was closed and the
wound drained.

COMPLICATIONS
1. Haemorrhage,
2. Infection,
3. Stricture urethra,
4. Incontinence,
5. Impotence,
6. Bladder neck contracture.

3. RETROPUBIC PROSTATECTOMY (MILLIN)
• Using a low, curved transverse suprapubic pfannenstiel incision, which
includes the rectus sheath, the recti are split in the midline and retracted to
expose the bladder. With the patient in the trendelenburg position,
• The surgeon separates the bladder and the prostate from the posterior aspect of
the pubis. In the space thus obtained, the anterior capsule of the prostate is
incised with diathermy below the bladder neck,
• Care being taken to obtain complete control of bleeding from divided
prostatic veins by suture ligation.

• The prostatic adenoma is exposed and enucleated with a finger.
• A wedge is taken out of the posterior lip of the bladder neck to prevent
secondary stricture in this region. The exposure of the inside of the
prostatic cavity is good, and control of haemorrhage is achieved with
diathermy and suture ligation of bleeding points before closure of the
capsule over a Foley catheter (inserted per urethram) draining the
bladder.
• It is done without opening the bladder.
• (It is not commonly practiced).

4. PERINEAL PROSTATECTOMY:
This has now been abandoned for the treatment of BPH.
5. LASER METHOD:
it is becoming popular
by using Holmium laser

DISCUSSION:
In the ancient era, the diagnosis was based not only on the pratyaksha
Pramana but also on the anumana pramana , agama pramana and upamana
pramana. But there were certain limitations for exercising those methodologies
especially pratyksha pramana due to some pratyaksha baadhaka hetus. This
pratyaksha badhaka hetus can be avoided today with the aid of advance
technology for diagnosis like Ultrasonography, Microscopic examination of
tissue, blood, pus culture, urine etc., auto analyzers for analysis of haematology,
biochemistry and bio-markers, 3D & 4D body CT scan, MRI etc.

So, with the help of these tools, diagnosis of mootraghata can be made
precisely on evidence based methodology by performing following
investigations i.e. imaging investigation (USG of KUB, TRUS, etc.) and
laboratory investigation i.e. (Sr.PSA, Sr.Testosterone, S.Creatinine,
Blood Urea, S. Alkaline Phosphatase etc.) which may be helpful to
correlate with BPH.

CONCLUSION:
Ayurveda science describes in detail about the diseases of urinary tract. Acharya
Vagbhata has classically divided the Rogas of Mutra in to two categories viz.
Mutra Atipravrittija and Mutra Apravrittija Rogas (A. S. Ni. 9/40). The disease
Prameha comes under the first group where as Asmari, Mutrakricchra and
Mutraghata fall under the second.
The symptom complex of both the Mutrakricchra and Mutraghata seems to be
overlapping each other, but Acharya Dalhana, Acharya Chakrapani, and Acharya
Vijayarakshita have demarkated the difference between them.

This difference is based on the intensity of “Vibhanda” or “Avarodha”
(obstruction) which is more pronounced in Mutraghata. Hence, it may be
considered that the Mutraghata is a condition in consequence with some kind of
Obstructive Uropathy either mechanical or functional; related either to upper or
lower urinary tract resulting in to either partial or complete retention of urine as
well as Oliguria or Anuria.
As per the aetiopathogenesis of mootraghata is concern, there is deranged
function of apana vayu along with the vitiation of kapha & pitta produces ama,
which ultimately causes srotoavarodha. The vitiated doshas travel through
sukshma nadis and finally lodge in basti, where upon further vitiation of apana
vayu leads to mootraghata.

Particulars Benign Prostatic Hyperplasia Carcinoma of Prostate
Size The size may be small to big The size usually not very big
Consistency Firm and elastic Hard
Surface Smooth Irregular and nodular
Sulcus Midline sulcus between two lateral lobes
is well defined.
Sulcus is usually obliterated.
Surface The gap between the enlarged
prostate and the lateral pelvic wall is
clear.
The gap is obliterated by invasion
of the cancer.
Rectal mucosa The rectal mucosa moves freely over the
enlarged prostate.
The rectal mucosa adherent and
cannot be moved over the
prostate.
Seminal vesicle Felt normal This may be invaded by the
tumor and felt hard and irregular.

Understanding of MUTARGHATA w.s.r to B.P.H

Understanding of MUTARGHATA w.s.r to B.P.H

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