Therapeutic potential of Uttar Basti and Varunshigravadi Ghanvati in the management of urethral stricture: A case report

Abstract INTRODUCTION: Urethral stricture is characterized by fibrosis of the urethral epithelium and underlying corpus spongiosum, resulting in a pathological narrowing of the urethral lumen and subsequent obstruction of urinary flow. Conventional treatments for urethral stricture, including urethral dilatation, direct visualized internal urethrotomy, and urethroplasty, are associated with recurrence, necessitating implementation of alternative therapeutic approaches. According to Acharya Sushruta, the urethral stricture can be correlated with Mutrotsanga , a subtype of Mutraghata. Uttar Basti is indicated as a key therapeutic intervention in the management of Mutraghata and is often used in Ayurvedic clinical practice for similar conditions. PATIENT INFORMATION: A 65-year-old male presented to the Shalyatantra outpatient department with complaints of increased urinary frequency, urgency, a weak urine stream, and a sensation of incomplete voiding persisting for the past 9 months. His surgical history included a transurethral resection of the prostate (TURP) 1 year ago, followed by direct visual internal urethrotomy and intermittent self-catheterization 7 months ago. The retrograde urethrogram (RGU) examination revealed a beaded appearance of the anterior urethra with multiple areas of narrowing in the mid-urethra, along with a narrowed bulbar urethra lacking normal dilatation, suggesting significant stricture formation. The posterior urethra appeared wide, likely due to prior TURP, and free contrast spillage was observed in the bladder, indicating possible high intravesical pressure due to urethral obstruction. THERAPEUTIC INTERVENTION: The patient underwent two cycles of Uttar Basti , each lasting 7 days, with a 7-day interval between the cycles, using Apamarga Kshara Taila (15 mL), Madhu (honey) (5 mL), and Saindhava Lavana (rock salt) (500 mg). Varunshigravadi Ghanvati (500 mg) was administered orally three times daily after food for 21 days. RESULTS: Following the completion of the treatment protocol, significant clinical and diagnostic improvements were observed in the patient. The International Prostate Symptom Score assessment indicated a reduction in symptoms, with the severity improving from severe to mild, reflecting enhanced quality of life. The urine flow rate showed improvement, suggesting better urinary passage. RGU findings demonstrated an increase in the lumen of the bulbous urethra compared to pretreatment imaging, indicating a reduction in stricture severity. CONCLUSIONS: The findings of this case report suggest that the combination of Uttar Basti with Varunashigravadi Ghanvati may be an effective intervention for managing urethral stricture, as evidenced by symptomatic relief, improved urinary flow rate, and an increased urethral lumen on imaging. These results highlight the therapeutic potential of Ayurveda in alleviating recurrent urethral stricture, offering a promising and accessible alternative to conventional treatments.