Académique Documents
Professionnel Documents
Culture Documents
D.SASHIKUMARAN
G.SAHAYAPRAGASH
E.P.C.PRIYADARSHANI
L.A.A.C.SUBHASHINI
KAVIDU KARUNARATHNA
INTRODUCTION
Urologyisthebranchofmedicinethatfocusesonthe
surgical and medical diseases of the male and
femaleurinarytractsystemandthemalereproductive
organs.
Theorgansunderthedomainofurologyinclude The
Kidney
Ureters
Urinary bladder
Urethra and the male reproductive organs (testes,
epididymis,vasdeferens,seminalvesicles,prostateand
penis).
Urology-associated issues
Benignprostatichyperplasia
Bladderstones
Kidneystone
Urolithiasis
Prostitis(prostateglandinfection)
Prostatecancer
Bladdercancer
Cystitis
Epididymitis
Kidneycancer
Retrogradeurethra
Testicularcancer
KIDNEYS (jDlal&
jDlafl! udxi msKa oajhx tafld jdu mdYj
ia:s;#
oa;fhd olaIsK
mdYj ia:s;# - iq$ks 9$7 v,ayk rla; fo# m%idod;aufl! jDlafl! - iq$Yd 4$31
Kidneysareoriginatedfromprasadabhagaofraktha
andmeda.
Bladder( jia;sh)
1. Originatedfromrakthaandkaphaanditboilfrompitta.
(Su.Sha.4/26)
2' kdNs mDIag lG uqIal .=o jxlaIKfYAMidx
taloajdria;kq;ajDlafl! ufOH jia;srfOdauqL#
basthiissituatedinthemidstofumbilicus,back,waist,scrotum,
rectum, groins and penis and it has one orifice and place with its
facedownwards.
3' w,jd bj rEfmk isrd iakdhq mrs.%y#
uq;%dYfhdau,dOdr# m%dKdh;kuq;a; iq$ks 3$18-24
the shape of the bladder is looks like alabu(pitcher gourd) and
supportedbysiraandsnayu.
Regulating blood pressure: Beside adjusting blood volume, the kidneys help
regulate blood pressure by secreting the enzyme renin, which activates the renin
angiotensin - aldosterone pathway Increased renin causes an increase in blood
pressure.
Su.Ni.3/18-24
Mutravaha nadi, fill the bladder by bringing
urine continuously just like the rivers
satisfying the ocean.
The urine, fill the bladder by oozing through
its wall, both during waking and sleeping
status, just as a fresh earthen pot kept
immersed in water up to its mouth gets filled
with water through its sides.
wdydr
wdydr mrsmpkh
wdydr rih
m%ido
lsg
ksIHkaokh
iafjo
uq;%dYh
iqlaIu fida;%ia
AccordingtoSushruta,derangementofvayuitself
isthechief causesforthepathologicalconditions
oftheMutrapravrathi.
Actofurinationofvoidingvitiationofvatadosha
and sthana-samshraya in basti leads to various
urinarydiseases.
Eg:Prameha
20
Ashmari
04
Mutraghata 13
Mutrakriccha 08
(Su.Su.21/33)
Pathology
Mithyahara Vihara / Abhighataja
Vata vaishamya
Basti desha sthana samshraya
Mutravikara or Mutraroga
CLASSIFICATION
General Classification:
A. Diseases of Urinary tract.
i. Mutraghataii. Mutrakricchra
iii. Ashmari iv. Prameha
1.
iii.Miscellaneous :
i. Mutrashukra
ii. Bastishula
iii. Mutraudavarta
iv. Mutrakta
v. Niruddha prakasha
i. With Obstruction:
In this group of disorders, obstruction to the free passage
of urine.
There will be mechanical cause leads to
obstruction:
Eg. Ashmari(urolithiasis), Ashtila (BPH), Niruddha
prakasha (pinhole meatus) (Su.Ni. 13/52,53,5).
ii. Disease with Dysuria : Painful micturition is the
dominant symptoms in this group. ( Su.Ut.59)
iii. Diseases with Urinary abnormalities : Change in
the characteristics of urine Eg. Prameharoga ( Su.Ni.
6/4)
Udakameha
Ikshumeha
Pittaja
Vataja
Ksharameda
Vasameha
Neelameha
Sarpimeha
Sandrameha
Shonitameha
Hastimeha
Surameha
Manjistameha
Kshoudrameha
Pishtameha
Haridrameha
Shukrameha
Sikatameha
Shanairmeha
Lavanameha
Phenameha
Shitameha
Alalameha
Amlameha
Kalameha
Madhumeha
Vatakundalika
Mutrakricchra
Miscellaneous
1.
Vataja
1.
Tuni
2.
Vatashtila
2.
Pittaja
2.
Pratituni
3.
Vatabasti
3.
Kapaja
3.
Mutravruta vata
4.
Mutratita
4.
Sannipataja
4.
Pratyastila
5.
Murajatara
5.
Abhighataja
5.
Basti shula
6.
Murtasanga
6.
Shakritjanya
6.
Mutraviddha
7.
Mutrakshaya
7.
Ashmari- janya
7.
8.
Sharkarajanya
8. Vitiation of mutravaha
srotus
8.
Mutragranthi
9.
Mutrashukra
10.
Mutroutasada - Pittaja
11.
Mutroutasada - Kaphaja
12.
Vitvighata - Caraka
13.
Bastikundala
9.
Parivartika
Niruddha Prakasha
Treatment of Mutraroga
udref; m%.=fK jiaf;! uq;%x iuHla m
%j;f;
ldrd Oiapdms m%;sf,dafu
Njka;sNs#
uq;%d>d;# m%fuyYap Y=l%fodaIdia
;ff:jp
uq;% fodaIdP fh floa jia;sfuj
Njka;sys#
iq$ks 3$27
W!jx m%jlaIHdx uq;% fodafI l%ux
ys;x
MUTRAKRUCHCHA
(uq;% lDP)
REVIEW ON MUTRARICCHA
NIDANA
Dietary Causes :
Tikshna oushadha sevana (Taking powerful/strong drugs)
Ruksha anna (Dry meal)
Atimadyapana (Excess intake of alcohol)
Anupa mamsa sevana (meat of marshy place animals)
Atimatsya sevana (Excess fish intake)
Adyashana (Over indulgence or intake of food)
Ajirna (Indigestion)
Physical strains:
Ativyayama (Excess Exercise)
Atimaithuna ( over indulgence in coitus)
Ati nritya karma ( Dancing)
Atidrita ( Fast riding)
Prishtayana ( riding vehicles, animals etc...)
SAMPRAPTI
The various mala (doshas) of the
body vitiates due to their own
vitiating causes. This vitiated dosha
singly or in combination vitiates
vasti, three by peedana (functional
derangement) of mutramarga, leads
to difficulty in micturition.
BHEDA
Vata
Pitta
Kapha
Sannipata
Ashmari
Shakrit
Sharkara
Abhighataja
VATAJA
MUTRAKRICCHRA(Su.U.59/4,PN.529)
Alpam alpam ( less quantity)
Vedana is mushka mehana and vasti (pain
in scrotum, penis and suprapublic
region)
Phalat bhiriva kricchrena ( difficulty
micturition)
Vataghanena mehati (all types of vata
vedana manifests).
PITTAJA MUTRAKRICHRA
(Su.U.59/5,PN 579)
Haridra mutra ( Yellowish urine)
Ushna mutra ( feeling hot during
urination)
Rakta mutrata ( blood in urine)
Agni dahayamana iva daha in mushka,
mehana and vasti (severe burning
sensation in scrotum, penis and
bladder area)
KAPHAJA MUTRAKRICCHRA
(Su.U.59/6,PN.580)
Snigdha (oil like/consistency of
urine)
Shukla (whitish urine)
Mushka, mehana, basti gurutva,
(heaviness in scrotum, penis and
suprapublic area)
SHALYAJA MUTRAKRICCHRA
(Su.U. 59/7, PN 580)
Due to injury to mutravaha srotas (urinary system)
it produces symptoms similar to mutraghata.
Injury to the uinary tract produces symptom
similar to vataja variety where severe pain,
frequency micturition, difficulty micturition,
pain in groin and scrotal area are common.
Above said symptoms appears in trauma of the
urinary system.
But the manifestation of
classically said symptoms depends on the type of
injury, site of injury.
SHARKARAJANYA MUTRAKRICCHA
(Su.U. 59/12 -14, PN 580)
Hrupida (chest pain)
Vepathu ( tremors)
Kukshishula ( pain in pelvic region)
Vahnidurbalala ( vitiation of agni)
Murcha ( fainting)
Mutraghata ( difficulty micturition)
If sharkara flushed out them vedanashanti.
(Subsidence of symptoms)
During passage of fresh sharkara, vedana
utpatti. (Appearance of symptoms).
TREATMENT OF MUTRAKRICHHRA
Swedana
Avagaha
Abhyanga
grita avapidana
trividha vasti karma (anuvasana,
asthanpana and uttara vasti) are
common procedures used for urinary
disorders (Su.Su.7/7)
MUTRAGHATHA
(uq;%d>d;)
MUTRAGHATA
NIDANA SAMPRAPTI (ETIOPATHOGENESIS)
Nidana :
(i) Vega avrodha ( suppression of natural urge
for micturition)
(ii) Vata vriddhikara ahara and vihara
( alteration of diet and activities which
vitiates vata dosha).
Dosha : Tridosha, pridomineatly vata dosha
Dushya : Mutra
Adhistana vasti
Samprapti
Vega avarodha
Vitiation of vata
Vitiation of mutra
Mutraghata
Classification
1. Types of mutraghata according to
sustrutha
Vatashtila
Vatabasti
Mutratita
Murajatara
Murtasanga
Mutrakshaya
Mutragranthi
Mutrashukra
Ushnavata
Mutrouksada - Pittaja
Mutroukasada
Kaphaja
Mutratita
3. ACCORDING TO DOSHA
:
Vataja
Pittaja
01.Vatakundal Pittaja
ika
Mutrouksada
02.Vatastila
03.Vatabasthi
04. Mutratia
05.
Mutrajatara
06.
Mutrasanga
07.
Mutrashukra
08. Vitighata
09.
kaphaja
Kaphaja
Vatakaphaja Vatapittaja
Raktagranthi Ushnavata
Mutsouksada
Mutrakshaya
4. ACCORDING TO CAUSE
NIJA ( Intrinsic)
AGANTUJA (Extrinsic)
1.Vatakundalika
1. Ushnavata
2. Vatastila
2. Mutrasanga
3. Vatabasti
3. Bastikundala
4. Mutratia
4. Vitvighata
5. Mutrajatara
6. Mutrakshaya
7. Mutrashukra
8. Mutrouksada
9.Mutrouksanda pittaja
10.Mutrokasada kaphaja
11. Vitvighata
5. ACCORDING TO
ETIOPATHOGENESIS
Inflammatory
Metabolic
Traumatic
Neoplastic
Neurogenic
1. Ushanavat
a
1. Mutagrant
hi
1. Mutrasang
a
1.Vatashtila
1.Bastikundali
ka
2.
2. Mutrakshay 2. Vivighata
a
3.
3. Pittaja
Bastikundal
a
Mutrasang
a
Mutrouksada
4. Kaphaja
Mutroukasada
2.
Mutragranthi
2. Vastabasti
3. Mutrajatara
4. Mutratita
6. ACCORDING TO LESION
Functional
Organic
i. Vatakundalika
i.
Mutragranthi
ii. Vatabasti
ii. Mutrashukra
iii.Mutratita
iii. Vitvighata
iv.Mutrajatara
iv. Vitastila
v. Mutrakshaya
v. Mutrasanga
vi.Mutrouksada pittaja
vi. Mutragranthi
vii.Mutrouksada kaphaja
vii.Ushnavata
viii Bastikundal
7.ACCORDING TO SPECIAL
SYMPTOMS
Mutraghata
Obstruction
Pain
+
Frequency
Burning
Haematuria
Vatakundalika
Vatashtila
Vatabasti
Mutratita
Murajatara
Murtasanga
Mutrakshaya
Mutragranthi
Mutrashukra
Ushnavata
Mutrouksada - Pittaja
Mutroukasada Kaphaja
Bastikundala
VATASHTILA
The vitiated apanavayu when takes seat in
the space between rectum ( guda) and
urinary bladder (basti)
produces, firm
(sthira) elevated (unnata), stone like
(astilavatgranthi) growth . This growth in
turn produces obstruction to passage of
faces, urine and flatus (Mala, Muta and
Anila Sanga) andAdhmana.
it leads to
intense pain (vedana) in suprapubic region.
(Su.U.59/7-9)
CHIKITSA (TREATMENT)
Abhyanga
swedana
vasti etc,
to be adopted along with these
measures, dashamula kashaya,
shilajitu along with sharkara to be
given orally ( for pana).
VATA KUNDALIKA
VATAVASTI
Etiology : Suppressing the urge of
urination
Pathology : Vata residing
in the
bladder gets aggravated, blocks the
mouth of the bladder
Symptoms: Retention of urine inside
the bladder and causing pain in the
bladder and abdomen
Prognosis :Difficult cure
(Su.U.58/9 10)
MUTRATITA
Etiology :Suppressing the urge of urine ( for a
long time) and then desires to eliminate it.
Pathology: Vitiation of vata
Symptoms: The urine does not come out or
comes out in little quantity after training, with
mild pain, less quantity, increased frequency.
(Su.U.58/3 4)
MUTRAJATARA
Etiology : Suppression of urge of urination
Pathology : Apana vata getting aggravated and
moving in upward directions and accumulates in
great amount inside the abdomen
Symptoms :Distention below the umbilicus,
severe pain, and obstruction of lower passages (
urethra and rectum)
(Su.U.58/13-14)
MUTRASANGA
MUTRAKSHAYA
Etiology :Persons who are dry and
fatigued
Pathology: Aggravation of pitta and
Vata located in the urinary bladder
Symptoms: Burning sensation, pain
in the bladder and difficulty for
urination
(Su.U. 58/17)
MUTRASHUKRA
Etiology : Indulging in copulation when
the urge of urination pronounced
Pathology: The semen mixed with urine
Symptoms: Semen mixed urine comes
out either before or some times after
urination and urine resembles solution
of ash.
Semen mixed urine may be compared
to retrograde ejaculation.
USHNAVATA
Etiology : Indulging in physical activities,
walking for long time or exposure to sunlight.
Pathology: Pitta gets aggravates and obstructs
by vata.
Symptoms: Burning sensation in the bladder,
penis and rectum during flow of urine. Urine
is yellow, mixed with blood or blood itself
comes out with difficulty.
(Su.U. 58/22-23)
PITTAJA MUTRAUKASADA
Aetiopathology: Vitiation of pitta
Symptoms: Urine becoming nonslimy, yellow, thick and dry flows out
accompanied with burning sensation
and resembling powder of ox gall in
color ( Yellow)
(Su.U.58/25)
KAPHAJA MUTRAUKASADA
Aetiopathogenesis
: Vitiation
of
kapha.
Symptoms: Urine being dry, thick,
white in color, eliminated with
difficulty. becomes dry resembling
powder or conch or very white.
(Su.U. 58/25)
VITVIGHATA
Vitvighata was explained in Caraka Samhita
was not mentioned in Sushruta Samhita.
Etiology: Vitiation of vayu in dry, debilitated
person.
Pathology: Leading to abnormal upward
movement of faecess.
This is nothing but colo-vesical or rectovesical fistula of various etiologies
TREATMENT OF MUTRAGHATA
Kashaya, Kalka, Sarpi (Ghritha), Bakhshya, Leha,
Payasa, Kshara, Mastu, Swedana, Basti and Uttar
Basti to be administered in mutraghata.
(SU. 58/27 28)
Baladi ghrita and Mahabaladi ghrita are some of the
compound drugs used for mutraghata. Most of the
drugs used in mutraghata are diuretic.
Some of the yoga mentioned in Sushruta Samhita :
Ervaruka bhija kalka + Saindhava Kanji
Souvarchala + Sura
Mamsa bhakshana + guda = Madya Madya
Kunkuma + Madhudaka
Dadima + Jiraka + Nagara + Ela + Saindhava = Sura
AHMARI
(wYaur)
ASMARI / UROLITHIASIS
Symptoms of Mutrasmari
Excruciating pain over nabhi, vasti, or
at sevani, medra during micturition.
Sudden stoppage of urine flow
Blood stained urine
Twisting and slitting of urine
Aggravation of pain during running
,jolting etc.
MUTRASMARI NIDANA
Teekshna Oushada sevana
Ruksha Madhya sevana
Anupa matsya sevana Sea Food- Fish,
Herring, Fish rhoe, Lobster, Crab, Prawns,
Shrimps, Sardines etc.
Ajeerna bhojana also alter the absorption at
the level of intestines ex:- Hyperuricosuric
calcium, secondary to dietary excess.
Athivyayama
Apathya sevana, diet having more oxalates
(e.g., Cabbage, rhubarb, spinach, coca,
black tea), uric acid and calcium containing
VATAJA ASHMARI
Patients complains
- severe pain in umbilical region or rubs his penis or
fingers his rectum and loudly screams.
- urination, belching and daefecation become
difficult and painful.
Ashmari
Dusky colour
Rough
Uneven in shape
Hard
Facetted and nodular like a Kadambha flower.
(Oxalate calculi/Staghorn calculi)
PITTAJA ASHMARI
Patients complains
Sucking, drawing, and severe burning pain
Symptoms
which
characterise
of
Ushnavatha.
Fever
Ashmari
yellowish, black colour
Like a Ballathaka fruit
Coloured like honey
(Uric acid stones)
KAPHAJA ASHMARI
Patients complains
Heaviness in bladder area
Pain comes when walking or jumping
Pain reduced when rest
Ashmari
White colour
Large size
Like a Hens egg
Colour of the Madhuka flower
(Phosphate stones)
SHUKRASHMARI
Usually formed in adults.
A sudden or abrupt stoppage of a
sexual act or excessive coitus tends to
dislodge the semen from its natural
receptacle.
Treatment of Mutrashmari
wYaur odrefKd jHdrka;l m%;sfuday;#
;refK fNIcx m:Hx m%jDoafO fPo uy;s
- Early stage medicinal treatments
- Later stages - chedana/surgery
Mainly
Shalya
Bhedana
Pathana
Treatments
Bhedana
Polpala,
akkapana,
shilajathu,
kuppameniya
Chandraprabha vati
Decoction
akkapana+polpala+lunuwarana
Pathana
Murunga, lunuwarana, kakiri, ranawara
Decoction murunga, lunuwarana
Mutrakaraka
Sarana, gokatu, truna panchamulaya
PRAMEHA
(m%fy)
PRAMEHA
Prameha is a syndrome which includes all
the
clinical
conditions
which
are
characterized by with more quantity and
increased
frequency
of
abnormal
micturition along with other symptoms.
Prameha can correlate in many ways with
Metabolic Syndrome and Diabetes mellitus.
Inclusion of Prameha among Maha Gada
group in Caraka Nidana Sthana shows the
significance of this disease.
of
Nidana
Classification of Prameha
Classification can be done based on :
i. Hetu (EtiologY)
ii. Deha Prakruti
iii. Dosha
According to Sushruta:
Hetu Bedhas (Biological Classification) of Prameha
prameha is of 2 types
i. Sahaja Pramehaa
ii. Apathyaja prameha
.
Sahaja Prameha
Roopa (Signs & Symptoms)
Prabhuta mutrata (More urination)
Avila mutrata (Frequent turbid
urination - Polyuria)
Krusha (emaciation)
Rooksha (Dryness of mouth & throat)
Alpashi (Loss of appetite)
Pipasa (afflicted with excessive thirst
(Polydipsia)
Types of Prameha
Vataja prameha - 04
Pittaja prameha - 06
Kaphaja prameha- 10
Vataja prameha
1. Vasameha
2. Hasthimeha
3. Sarpimeha
4. Kshaudrameha
Pittaja meha
1.
2.
3.
4.
5.
6.
Ksharameha
Nilameha
Manjishtameha
Haridrameha
Shonithameha
Amlameha
Kaphaja meha
1. Udakameha
2. Ikshuwalikameha
3. Sandrameha
4. Surameha
5. Pishtameha
6. Shukrameha
7. Sikathameha
8. Kshanairrmeha
9. Lavanameha
10.Phenameha
Thank you.