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Lord Dhanwantari
 
 
 

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
 
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)
Figures in paracenthesis indicate percentage.

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

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)
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)
Figures in paracenthesis indicate percentage

7.      Recurrence: Recurrence is seen nearly 2 -3 % cases.  

8.      Number of Uttarbasti required for complete relief -

           

Number of uttarbasti Number of patients ( % )
05 284 ( 70 )
07 110 ( 27 )
11 012 ( 3  )
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   406

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).

Retrograde Urethrogram Pre Treatment Retrograde Urethrogram Post Treatment
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