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Management of Urethral Stricture by Uttarbasti :
Up till now more than 1500 patients were treated by this procedure. The data of 406 patients is statistically analyzed as below.
Material and Methods:
Material:
Drugs – Medicated Oil & Equipments Required
Methods:
Inclusion Criteria :
· 406 well diagnosed male and female patients of all age groups.
Exclusion Criteria:
· With acute urinary tract infection
· With neoplasms of lower urinary tract
· With benign prostatic enlargement
· With impacted calculus in urethra and bladder neck.
Observations:
Parameters for grading of symptoms and relief of the patients:
Symptoms of urethral stricture (mutra marg sankoch) present at first visit were graded and followed up after each uttarbasti as |
| Symptoms |
Severe |
Moderate |
Mild |
Complete relief |
+++ |
++ |
+ |
- |
|
| |
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| Symptoms |
Total Patients |
Severe Moderate Mi |
After 5th Uttarbasti Procedure |
No response to Treatment |
Present before treatment |
Complete relief |
Slight relief |
| Straining at Micturition |
406 |
338 |
68 |
- |
365 |
41 |
Nil |
| Burning Micturition |
406 |
256 |
135 |
15 |
338 |
68 |
Nil |
Decreased
stream |
406 |
392 |
14 |
- |
311 |
95 |
Nil |
| Prolonged Micturition |
406 |
41 |
311 |
54 |
378 |
28 |
Nil |
| Frequency of micturition |
392 |
108 |
189 |
95 |
338 |
54 |
Nil |
| Stangury |
328 |
82 |
246 |
- |
314 |
14 |
Nil |
| Incontinence of urine |
122 |
27 |
81 |
14 |
122 |
- |
Nil |
| Haematuria |
81 |
- |
27 |
54 |
81 |
- |
Nil |
| Retention of urine |
14 |
14 |
- |
- |
14 |
- |
Nil |
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Profile of Patients:
Incidences of urethral stricture in relation with
1. Sex: More common in males (96.67%) and very less in females (03.33%).
Sex wise distribution of patients |
| Sex |
Number of patients |
Male |
393 (96.6) |
Female |
13 (3.4) |
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Figures in paracenthesis indicate percentage.
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2. 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 |
No. of patients |
| 0-15yrs |
0 (00.00) |
| 16-30yrs |
13 (03.2) |
| 31-45yrs. |
203 (50.00) |
| 46-60yrs |
190 (46.79 |
Figures in paracenthesis indicate percentage
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3. Marital status: 70% cases were married while 30% cases were unmarried
4. Aetiological factors: 70% of 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 16.50% (Incidences shown in table 3).
Classification of patients of urethral stricture according to Etiological factors |
Etiological factors |
No. of patients |
| History of exposure (post gonorrheal) |
284 (69.95) |
| Instrumental (Indwelling catheter) |
67 (16.50) |
| Traumatic Rupture urethra) |
41 (10.10) |
| Post surgery (Renal calculi) |
8 (1.97) |
| Post meatotomy |
5 (1.23) |
Post circumcision |
1 (00.25) |
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Figures in paracenthesis indicate percentag |
5. Prakruti: 83.33% cases were of vat-kapha prakruti and 16.66% of vata-pittaj prakruti |
6. Site of Stricture:
Distribution of the patients according to the site of the stricture |
| Site of the stricture |
Number of patients |
| Membranous urethra |
230 (56.65) |
| Junctional urethra |
108 (26.60) |
| Prostatic urethra |
41 (10.10) |
| Penile urethra |
27 (6.65) |
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| Figures in paracenthesis indicate percentage |
7. Recurrence: Recurrence is seen nearly 2 -3 % cases.
8. Number of Uttarbasti required for complete relief -
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| Number of uttarbasti |
Number of patients ( % ) |
| 05 |
284 ( 70 ) |
| 07 |
110 ( 27 ) |
| 11 |
012 ( 3 ) |
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| Number of uttarbasti procedures required for complete relief. |
| Pre procedure |
Post procedure |
| Uroflow (ml/10sec) |
Number of patients |
Uroflow (ml/10sec) |
Number of patients |
| 00-20 |
35 |
100-120 |
79 |
| 20-40 |
83 |
120-140 |
213 |
| 40-60 |
261 |
140-160 |
92 |
| >60 |
27 |
>160 |
22 |
| Total |
406 |
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406 |
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Figures in paracenthesis indicate percentage. |
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 above 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 up to 140-160ml/10sec. No post procedural complications, delayed complications and adverse effects were observed.
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 compared to present common techniques and could prove a blessing to the patients of urethral stricture (mutramarg sankoch). |
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| Retrograde Urethrogram Pre Treatment |
Retrograde Urethrogram Post Treatment |
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