Urethral Stricture - Ayurvedic Aspect

Ayurvedic Aspect

Causes (Etiology):

1. Drinking water or eating when the bladder is full and urge to pass urine is present.
2. Suppressing micturition.
3. Excessive indulgence in intercourse.
4. Exhaustion and injury lead to diseases of urinary bladder.
5. Akalyonigamana, Ayonigamana, Mastrubation.
6. Forceful control of sexual desire, extensive sexual practice and trauma to reproductive organ by means of surgery i.e. shashtra, kshar and Agni.
7. Dhwajbhanga (extragenital intercourse, intercourse with a lady having vaginal, gynaecological disorder, who has not done intercourse since long period of time, during menstruation).

Shushruta Described Urinary Tract Disorder of Two Type :

1) Mutraghat
2) Mutrakruchra

1) Mutraghat : Obstruction to passage of urine - 12 types:

1) Vatkundalika     2) Vatashtila    3) Vatbasti    4) Mutrateet    5) Mutrajathar    6) Mutrotsang    7) Mutrakshya    8) Mutragranthi    9) Mutrashukra    10) Ushanvat    11) Pittajmutrotsad    12) Kaphajmutrotsad

Mutrakrichra :

Obstruction to urine is much or less but micturition is usually associated with pain, burning and difficulty.

Type :

A) Vataj    B) Pittaj     C) Kaphaj    D) Sannipataj    E) Abhighataj    F) Ashmarij    G) Sharkaraj    H) Shakrut

Mutramarga Sankoch (Lakshana - Sign and Symptoms) :

1. Difficult, frequent, painful, prolonged micturition with straining with little amount of urine.
2. Sign of retention of urine.
3. Pain in lower abdomen, flank, scrotum, perineum.
4. Haematuria.
5. Physical appearance of urine change dark, yellowish, reddish.
6. Stream of Urine is either thin or bifurcated.

Samprapti of Mutramarga Sankoch (Pathogenesis)

According to Charaka, the basti is vatsthana an apan vayu is seated at testicles, bladder, guda, penis etc. and responsible for normal evacuation of bladder, bowel, and ejaculation. The diseases occurring in this region are mainly due to vat dusthi.

Increase in khar, Ruksha guna responsible for local constriction and hardening of tissues leading to constriction of urethra. Increase in chala guna leading to frequent micturition and cause pain. When vayu get stage of prakopa it causes mutra sanga, tod (thrombing pain), Sankoch (Stricture), shosha and shoola.

Kapha prakop is manifested with sthairya as local stasis, gaurav as heaviness in penis in mutrosanga, uplepa (narrowing of lumen) due to hypertrophied scar tissues, bandha (obstruction to normal flow) chirkaritwa (chronicity).

Hence combination of Vat +++ and kapha + is causative factor doshas behind the mutramarga sanchoch i.e. urethral stricture.

Urethral passage is lined by mucosa which is shleshmadharakala / internal lining which may be considered as updhatu of Mansa. It gets affected and diseased mucosa promoted the disease to submucosal structure and their involvement lead to stricture. Twachas is updhatu of Mansa which is nourished by Rasa and Rakta hence in this disease Rasa Rakta, Mansa are affected Dhatus.

Mutravaha strotas is involved hence Mutra is among the dushyas. As Mutra prasek is common pathway for Mutra and Shukra in male so Shukra is also involved in this disease.

Dosh Dushya Samurchana of Mutramarga Sankoch :

Dosha	Vat	+ + +
	Kapha	+
	Dhatu	- Ras
		- Rakta
		- Mansa Twacha
		- Shukra
	Mala	- Mutra.

Sadhya Sadhyatwa (Prognosis) :

Mutra Marga Sankoch (Urethral Stricture)- Yapya vyadhi