BHP-repertorial approach and homoeopathic management.

June 7, 2022 admin Articles 1

Dr Maria Shaju

Introduction

Prostate is the largest male accessory gland. Benign Prostatic Hyperplasia is a non cancerous enlargement of Prostate Gland, where it pushes the urethra and bladder, thereby obstructing the flow of urine.The prevalence of BPH rises with increased age. Autopsy studies observed a histological prevalence of 8%, 50%, and 80% in the 4th, 6th, and 9th decades of life, respectively. [1]

PATHOPHYSIOLOGY OF BPH
After the age of 30, men produce about 1% less testosterone. But 5 alpha reductase enzyme increases with age. Thus there will be increase in the production of dihydrotestosterone (DHT). DHT is more potent than testosterone and thus it binds with androgen binding receptors present both in stromal and epithelial cells and facilitate the proliferation of stromal cells and decreasing the death of epithelial cells.

CLINICAL FEATURES

  • Hesitancy- trouble initiating urination.
  • Dysuria
  • Increased frequency of urination- sense of increased bladder emptying.
  • Increased urgency.
  • Weak and inconsistent stream of urine (dribbling)
  • Hematuria

DIAGNOSIS

  • A Digital Rectal Examination
  • Ultrasonography
  • Transrectal ultrasound scanning
  • Cystoscopy
  • Prostate Specific Antigen blood test.

TREATMENT

CONSERVATIVE MANAGEMENT

  • Regular prostatic massages may combat prostatic congestion.
  • Patient should be cautioned against excessive intake of fluids in a short period of time to protect vesical tone.
  • Alcohol should be forbidden due to its diuretic action.
  • Use of anti androgen therapy.

Testosterone has improved obstructive symptoms by increasing vesical tone.

MEDICATIONS

  • Alpha blockers.These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers —alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostate.
  • 5-alpha reductase inhibitors.These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — finasteride (Proscar) and dutasteride (Avodart).
  • Combination drug therapy. alpha blocker and a 5-alpha reductase inhibitor. [2]

SURGICAL MANAGEMENT

  • Prostatectomy- removal of a part or all of prostate gland.
  • Suprapubic prostatectomy
  • Retropubic prostatectomy
  • Transurethral prostatectomy
  • Perineal prostatectomy
  • Trans Urethral Resection of Prostate.
  • Trans Urethral Microwave Therapy.
  • Laser Enucleation.

HOMOEOPATHIC MANAGEMENT

REPERTORIAL APROACH

KENT REPERTORY [3]

  • Bladder, Retention of Urine ,Enlarged Prostate from
  • Bladder , Urination dribbling, Enlarged Prostate from
  • Prostate Gland , Enlargement ,Dribbling Urine after stool &urine
  • Prostate Gland, Enlargement, Senile

BTPB [4]

  • Urine, micturition, urging ineffectual, fruitless with
  • Urine, micturition, urging, irresistible hurried
  • Urine, micturition, drop by drop (strangury)
  • Prostate gland, enlarged swelled,
  • Urine, micturition, urination, frequent too, night

PHATAK REPERTORY [5]

  • Prostate Gland, enlarged
  • Prostate Gland, enlarged, senile

BOERICKS REPERTORY [6]

  • Male sexual systems, Prostate Glands, Hypertrophy

SYNTHESIS REPERTORY [7]

  • BLADDER- RETENTION of urine- accompanied by- prostate gland; swelling of
  • BLADDER- URINATION, dribbling- enlarged prostate, with
  • BLADDER- URINATION , interrupted, spurts and with each spurt cutting pain in swollen prostate in
  • BLADDER-URINATION, involuntary, accompanied by, prostate gland; swelling of
  • BLADDER- URINATION, involuntary, old people, in men with enlarged prostate

REPERTORY OF HERINGS GUIDING SYMPTOMS OF OUR MATERIA MEDICA- CALVIN B KNERR [8]

  • MALE SEXUAL ORGANS, PROSTATE GLAND, affections
  • MALE SEXUAL ORGANS, PROSTATE GLAND, enlarged
  • MALE SEXUAL ORGANS, PROSTATE GLAND, enlarged, hypertrophy
  • MALE SEXUAL ORGANS, PROSTATE GLAND, enlarged, old men, in
  • MALE SEXUAL ORGANS, PROSTATE GLAND, enlarged, urine, with retention of

HOMEOPATHIC THERAPEUTICS

CHIMAPHILA UMBELLATA

  • Frequent urge to urinate.
  • Sensation of ball in the perineum.
  • Burning sensation while passing urine and patient has to strain before passing urine.
  • Has to stand with their legs wide apart and body bend forward to pass urine
  • Sharp stinging pain in urethra from the neck of the bladder to external urethral orifice.
  • Acute inflammation of prostate.
  • Discharge of prostatic fluid.

CONIUM MACULATUM

  • Difficulty in passing urine.
  • Interrupted flow of urine.
  • Increased desire for sex but no energy.
  • Suited for those who are apprehensive, depressed and scared of being alone.

DIGITALIS PURPURA

  • Suited for enlarged prostate with heart problems and history of gonorrhea.
  • Constriction and burning in urethra as if there were narrow.
  • Constant urge to pass urine with painful dribbling.
  • Urinary retention.
  • Brick dust sediment in urine
  • Throbbing pain at the neck of the bladder which worsen at night.
  • Feeling fullness in bladder even after urination.

SABAL SERRULATA

  • Suited for patients with chronic gonorrhea with enlarged prostate.
  • A frequent urge to urinate at night
  • Difficult passing urine and feeling of coldness in sexual organs
  • Discharge of prostatic fluid
  • Used in lower potencies for urinary incontinence in older men.

THUJA

  • Forked and small or divided urinary stream
  • Frequent urge to urinate, with cutting or burning pain felt near the bladder neck, this remedy may bring relief.
  • After urine passes, a dribbling sensation may be felt.
  • Conditions worse at night, from heat of bed, at 3am and 3 pm.

CLEMATIS ERECTA

  • Indicated when swelling of the prostate seems to have narrowed or tightened the urinary passage.
  • Urine usually emerges slowly, in drops instead of a stream, with dribbling afterward
  • CAUSTICUM
  • Urine loss when the person coughs or sneezes often indicates a need for this remedy.
  • Once urine has started passing, the person may feel pressure or pulsation extending from the prostate to the bladder.
  • Causticum is also indicated when sexual pleasure during orgasm is absent or diminished.

POPULUS TREMULOIDES

  • Severe tenesmus, Dysuria and scalding.
  • Pain behind pubis at the end of micturition.
  • Weight, pressure and aching in pelvis and vesical tenesmus with frequent desire to micturate.
  • Little pain during micturition but as soon as the last drops were voided or a little before a severe cramp-like pain just behind pubes lasting ten to fifteen minutes.
  • Very copious discharge of urine and irritation of bladder and urethra.

PARIERA BRAVA

  • Pains down the thighs and feet when attempting to pass water
  • Prostatic enlargement with Dysuria
  • Prostatic affection with constant urging with entire inability
  • Only on hands and knees with entire inability
  • Dribbling of urine after micturition
  • Enlarged prostate with retention; severe attacks two or three times a year.
  • Micturition difficult with much straining only in drops with sensation as if urine should be emitted in large quantities.
  • Enlargement of prostate gland with retention of urine; pain extending down the thighs.

HYDRANGEA ARBORESCENS

  • Vesical sphincter- irritation, with dribbling of urine, severe spasms of prostate, renal catarrh, yellow sand in the urine , even small calculi.
  • Urine hard to start, heavy deposits of mucous.
  • Great thirst with abdominal symptoms and an enlarged prostate.
  • Spasmodic stricture.
  • Burning in the urethra and frequent desire.

FABIANA IMBRICATA

  • Inflammation of whole urinary tract.
  • Excoriating urine.
  • Burning after urination.
  • Painful urination, much mucus and pain.
  • Useful in Prostatitis, Dysuria, cystitis with suppurative prostatic conditions. [9]

REFERENCE

1] Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. The Journal of urology. 1984 Sep 1;132(3):474-9.

2] Das S. A Concise Textbook of Surgery, 6 [sup] th ed. Calcutta: Dr. S. Das. 2010:1137-51.

3] Kent JT. Repertory of the homoeopathic materia medica. B. Jain Publishers; 1992.

4] Allen TF. Boenninghausen’s Therapeutic Pocket Book. B. Jain Publishers; 2003.

5] Phatak SR. Concise Repertory of Homoeopathic Medicines. B. Jain Publishers; 2004.

6] Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory: Comprising of the Characteristic and Guiding Symptoms of All Remedies Including Indian Drugs. B. Jain publishers; 2002.

7] Schroyens F. Synthesis Repertory Version-9.1 Repertorium Homeopathicum Syntheticum.

8] Knerr CB. Repertory of Hering’s Guiding Symptoms of our Materia Medica. New Dehi: B. Jain Publishers (P) Ltd.; 2004.

9] Boericke W. Boericke’s New Manual of the Homoeopathic Materia Medica with Repertory. New Delhi: B. Jain Publishers(P) Ltd.; 2007.

Dr Maria Shaju MD Part 1
Department of case taking and repertory
Under the guidance of Dr Munir Ahmed R
Government Homoeopathic Medical College and Hospital, Bengaluru

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