INTRODUCTION Benign prostatic hyperplasia is one of the most common urological diseases affecting millions of men worldwide. The pooled prevalence of BPH worldwide is estimated to be 26.2%, where the prevalence is 14.8 % in younger males aged 40 and it is 36.8 % in males aged 80 and above. It is characterised by a benign overgrowth of prostatic tissue around the urethra which ultimately constricts the urethral opening, resulting in lower urinary tract symptoms. The symptoms associated with LUTS include urgency, frequency, nocturia, incomplete urination and weak stream. The condition is associated with interference in daily activity of patients to produce a negative impact on quality of life. Many other complications associated with BPH include acute urinary retention, chronic urinary retention, urinary tract infections (UTIs), formation of bladder calculi, hematuria and damage to bladder walls and kidneys. The management of BPH is divided into conservative, medical and surgical with latest technological advances but each of them has its own limitations. Approximately, 10% of patients who have undergone Transuretheral Prostectomy or open Prostectomy for BPH has subsequently develop cancer. Although, surgery is the choice for treatment, but due its expensiveness and number of complications, ayurvedic approach towards the disease can provide promising results. In Ayurveda classics, there is vast description of group of obstructive uropathies under the heading of “Mutraghata”. In Vatasthila Vyadhi, which is a type of Mutraghata may have some similarity with Benign Prostate Hyperplasia on the basis of symptoms like Achala Unnata Granthi (singly movable and elevated swelling), Vinmutranilasanga (retention of urine, faeces and atus), Bastiadhmana (distention of urinary bladder), Vedanachaparabastou (excretion pain in bladder). In Vatasthila, the predominant feature is “Vibandha” or “Avarodha”. According to Acharya Dalhana, Vata is the main factor in the pathogenesis of Mutragahata. In the classics, Acharya Sushruta decided general line of management of all types of Mutraghata by use of Kashaya, Kalka, Sarpi, Bhakshaya, Avaleha, Payasa, Kshara, Madya, Asava, Swedana, Basti and Uttarbasti and formulations told in context of Ashmari and Mutrodavarta diseases. Hence keeping all these in mind, clinical study using Tilanala Kshara mentioned in Rasatarangini, which advocates its use in managing urine obstruction, was designed as a treatment modality in BPH. CASE REPORT CASE 1: A 65 years old male patient with chief complaint of Dribbling micturition, frequent micturition and Nocturia since 5 months was presented in institute hospital. On examination, patient was afebrile, conscious, well-oriented, responding to verbal commands. The patient was treated on the basis of OPD. The patient is known case of Hypertension and Diabetes since 6 years. He was on anti-hypertensive drug Telma 40 (40mg) once daily and Glycomet (500mg) twice a day. On examination, pulse rate was 80/min and blood pressure was 170/100 mmHg. On the basis of his clinical presentation, Routine Haematological investigations, Blood sugar (F&PP), Urine Routine and Microscopic, serum PSA and was investigated. Ultrasonography for prostate enlargement was performed. All the haematological and biochemical investigations were within normal limits. His serum PSA level was also in normal limit. The ultrasonography reveals Prostatomegaly (measures 4.3 x 5.0 x 3.7 cm, volume 42cc). After getting diagnosed with BPH, the treatment with Tilanala TILANALA KSHARA IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) – A CASE STUDY Original Research Paper Bharat Bhushan Pg Scholar, College Of Ayurveda, Bharati Vidyapeeth (deemed To Be University), Pune X 1GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Ayurveda th thBenign Prostatic Hyperplasia is associated with ageing process and most frequently seen in 5 and 6 decade of men. It has signicant impact on the health as well as it decreases the quality of life of the person suffering from it. Ayurveda classics have described it under the heading of Mutraghata and have similarity to its subtype Vatasthila, with predominant symptoms of urgency, dribbling micturition, urine retention etc. There is no permanent and safe cure with modern medicine, except surgical invasion, which will lead to more complications. A 65 years patient diagnosed with prostatomegaly has visited the O.P.D. of Bharati Ayurveda Hospital, Bharati Vidyapeeth University,Pune. The presentation of patient was comparable to Vatasthila, a subtype of Mutraghata and the treatment was carried out as per the classics. The patient was given Tilanala Kshara along with regulated diet and lifestyle. Assessment was made using International Prostate Symptom Score (IPSS) on 0, 5, 10, 15 day of treatment. At the end of the treatment there was considerable improvement in the subjective parameters. The observations revealed that the use of Tilanala Kshara can play a key role in the management of patients suffering from BPH. Further controlled pilot studies are required to establish the proof of efcacy in a systematic way. @ SUMMARY Benign prostatic hyperplasia is among the most common urological diseases in men and estimated to be 26.2% in men between the age group of 40-60 and above. There is a benign overgrowth of prostatic tissue resulting in lower urinary tract symptoms. The condition further leads to interference in daily activity of patients and create a negative impact on the quality of life. The management of BPH can be done by medical and surgical interferences but they are associated with few limitations. Ayurveda has its own principles in treating the condition, among which use of Kshara is one of them. The present paper deals with administration of Tilanala Kshara in a patient with clinical presentation of BPH. The assessment score using International Prostate Symptom Score (IPSS) has shown signicant improvement in the subjective parameters. Hence, the use of Tilanala Kshara can be used as an alternative treatment protocol for the disease BPH. ABSTRACT KEYWORDS : Benign Prostatic Hyperplasia, Mutraghata, Vatasthila, Tilanala Kshara, Ipss VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Amit A. Paliwal* Assistant Professor, College Of Ayurveda, Bharati Vidyapeeth (deemed To Be University), Pune *Corresponding Author 2 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Kshara was carried out for 15 days along with follow up. MATERIAL AND METHOD Tilanala Kshara was prepared as per classical text and administered in dose of 500 mg half an hour before meal orally with Luke warm water for 15 days. ASSESSMENT CRITERIA Sign and symptoms on the basis of relief of nocturia, frequency, dribbling, and urgency were scored by using International Prostate Symptom Score (IPSS) sheet on 0, 5, 10 and 15th day. VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra In the past month Not at All Less than 1 in 5 Times Less than Half the Time About half the Time More than half the Time Almost Always 1. Incomplete Emptying (How often have you had the sensation of not emptying your bladder?) 0 1 2 3 4 5 2. Frequency (How often have you had to urinate less than every two hours?) 0 1 2 3 4 5 3. Intermittency (How often have you found you stopped and started again several times when you urinated) 0 1 2 3 4 5 4. Urgency (How often have you found it difcult to postpone urination?) 0 1 2 3 4 5 5. Weak Stream (How often have you had a weak urinary stream?) 0 1 2 3 4 5 6. Straining (How often have you had to strain to start urination?) 0 1 2 3 4 5 None 1 time 2 times 3 times 4 times 5 times 7. Nocturia (How many times did you typically get up at night to urinate?) 0 1 2 3 4 5 Total I-PSS Score: 1-7: Mild8-19: Moderate 20-35: Severe Quality of Life Due to Urinary Symptoms Delighted Pleased Mostly Satised Mixed Mostly Dissatised Unhappy Terrible If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that 0 1 2 3 4 5 6 OBSERVATIONS AND RESULT IPSS 0 Day 5th Day 10th Day 15th Day Incomplete Emptying 3 3 3 2 Frequency 2 2 2 1 Intermittency 1 1 1 2 Urgency 2 2 2 2 Weak Stream 2 2 2 2 Straining 2 1 1 2 Nocturia 3 3 2 2 Quality of life due to Urinary Symptoms 4 3 3 3 Total 19 18 16 16 DISCUSSION B.P.H. is a frequent nding in older men and about three fourth of all men over 60 years of age experience its symptoms. Prostatectomy, the primary approach to the management of BPH, accounts for 38% of all major urological surgery in USA. In India, it has been reported that post-operative mortality is 3% and a high morbidity of nearly 20% is found in immediate post-operative phase with 2 – 3 % late complications including incontinence and up to 15% of potency problems (Ref. D. D. Karanjwala 1990). All these considerations provided a rm launch pad to foray in to the therapeutic alternatives, which could be provided from the heritage of Ayurveda, the science of life. Kshara is alkaline substance obtained from ash of plants, minerals and animal products. It is superior among the sharp and subsidiary instruments because it can perform Chedana (excision), Bhedana (incision), Lekhana (scrapping) and destroys the Tridoshaja disorders. Tila possess Madhu-katu- kashaya-tikta Rasa, Guru-snigdha guna, Ushna virya, Madhura vipaka and have Vatahara property, thereby balances the vitiated Vata in Mutraghata. The Kshara being alkaline substances have high content of potassium, thereby they act as diuretics, hence relieves the obstruction present in BPH. Thus, by above all the properties of Tilanala kshara, it acts effectively in reducing the sign and symptoms of BPH and improves the quality of life of them patient suffering from this disease. CONCLUSION However, the exact etiology of BPH is unknown, being a disease caused by vitiated Vata and urine obstruction being the predominant symptom, the oral administration of Tilanala Kshara proves effective to lessen the sign and symptoms. In IPSS score, there was relief in incomplete voiding, frequency, Intermittency, straining, weak stream and nocturia along with improvement in the Qualilty of life. 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