Uttarbasti – a medicinal oil-based treatment of urethral stricture

What is it?

See: http://urethralstricture-cure-in-ayurved.com/  (Uttarbasti is introduction of Sesame oil + Honey + Rock salt into urethra). Basically a glass syringe 40ml is used for this purpose.

Alternative (see this), “Medicated oil or decoction is introduced into the urinary bladder with the help of a rubber catheter through the urethral opening under aseptic conditions.”

A further ayurvedic doctor uses “disposable feeding tube no. 9“. This post claims that INFANT FEEDING TUBE can be used. [This Hindi blog post also describes its results – but no proof is offered]

Note that the size of a meatus is around 0.3 inches (this study). There is a video on Youtube that shows how this is done.

MY EXPERIENCE

I had a sub-meatal stricture and attempted this myself (pretty straightforward with a standard 5mm or 10 mm plastic syringe from the pharmacy). In my case this therapy DID NOT WORK. It did not slow down the rapid recurrence of the stricture after urethrotomy.

I therefore needed to get urethroplasty done – which has worked.

Papers that claim that uttarbasti works:

K. Rajeshwar Reddy’s study

This seems to be a tolerable quality paper: Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture

Even though this study is published by a shoddy journal (An international quarterly journal of research in ayurveda), it is featured on the website of the US National Library of Medicine, National Institutes of Health. That doesn’t make it a good study, but perhaps its results can be considered – with a pinch of salt.

In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters.

Basically, uttarbasti works in the short term as well as dilation but has SIGNIFICANTLY fewer rates of recurrence.

But note that patients selected for this study had “mild to moderate” stricture. No one had a severe stricture.

Rajendra H Amilkanthwar’s work

Rajendra H Amilkanthwar is probably the most prominent ayurvedic doctor to make this claim. He got a clinical trial approved by the US government in 2007 but DID NOT COMPLETE IT. His claims (which clearly did not qualify the stringent requirements of the US government) are published in a paper: Role of uttarbasti in management of mutra marga sankoch (urethral stricture) – Rajendra H Amilkanthawar

Interestingly, he claims that his research has been uploaded on the US government website, which seems to be false:
The author is working as a assistant professor in the subject of Shalyatantra (Surgery in Ayurveda) from last twenty years in Govt. Ayurvedic Colleges in Maharashtra state. He has previously worked at Nagpur & Osmanabad and currently working at Govt. Ayurved College, Nanded in Maharashtra, India.
He is involved in the field of research since 1992. He is working in the field of urology applying the innovative techniques from Ayurveda – the traditional health science of India. With special interest in Urethral Stricture, he has treated over 1500 patients from India and abroad. He has got immense success with the procedure of Uttarbasti in the condition of urethral stricture. Over 95 % patients have been cured.
Research work was accepted by NISCAIR and published in Indian Journal of Traditional Knowledge (IPC Int.Cl7 : A61K35/78; A61K25/00; A61P13/02; A61P13/00.
The work has been conducted under the scheme of Research Fellowship for Teachers, sponsored by Maharashtra University of Health Science, Nashik. The work has been successfully completed and uploaded on clinical trials.gov, an official website of National Institute of Health of US. [Sanjeev: this claim is false, since no completed work has been uploaded]
Research work presented in MASICON surgeons’ conference and many national and international conferences. [Source]

A further case study:

Case report: “Management of urethral stricture with Uttara Basti”  by Dr. T.S. Dudhamal, Dr. S.K. Gupta, Prof. C. Bhuyan

This one takes a single case and is not robust. It also does not undertake longer term follow up.

Further:

A case study here that is very sketchy, refers to some ayurvedic medicines and has no formal documentation.

Further:

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. [Source]

See this.

In this webpage, two self-declared auyurvedic doctors say that uttarbasti can reduce symptoms but won’t cure them. Plus Uttarbasti has HIGH RISK OF INFECTION.

Centres that claim to use this method to treat patients:

http://www.cureurethralstricture.com/uttarbasti.html

Most of the patients require ten sittings which are usually done on alternate days. 

Total duration of treatment is approximately 20 days.

Sunil Kahlekar

A doctor sunil kahalekar cured a patient who reported this on youtube.

This patient wrote a blog post on in which Sunil was cited.


His details.

INJECTING OILS OR OTHER THINGS INTO THE PENIS TIP

Uttarbasti involves injecting oil + honey into the urethtra through the penis tip.

Likewise here is a person who has injected hydrogen peroxide into his penis tip [You’ll need to find a 4 to cc syringe,…a plastic one preferred, so you can easily round off the sharp EDGE of it’s output,..so that when you insert it into your urethra/end of penis or in women the other part. You dilute the 3% Hydro to 1.5% via tap water. From that solution in a small cup, or premixed as 1.5%, in an old Hydrogen Peroxide container.
Draw into your syringe at least 2 CC’s of this 1.5%,…and after urinating inject this amount into your Urethra, up into and past the Prostate, or if  you figure the infection is below, in or above the rostate,..simply feel for what will be instant relief, as the 1.5% starts to bubble away at the infection. Hold the tip of the Syringe SEALED in the end of the Penis/womens part,.. and keep it sealed against the syringe tip, by clamping the end of the penis closed, clsing the emptied end of the syringe as the Urethra plug. Hold this dilute solution of Peroxide in your Urethra for 25 to 35 seconds,..and then removing the plug/syringe, as you will have a sensation of peeing, as part of the infection fluids and 1.5% hydrogen peroxide are expelled. Repeat this twice in the morning”

Further:

There is a claim made by someone (a patent) that a herbal mixture can cure strictures.

Homeopathic treatment

While on this subject, there seems to be some claims on the internet that homeopathy has reduced the need for dilation: https://hubpages.com/health/Homeopathy-Safe-Natural-Cure-For-Urethral-Strictures

  • but a couple of patients admitted it didn’t work; and finally had to undergo the plasty operation.

Aloe vera for urethral stricture

I’ve had superb results with aloe vera and have used it virtually everywhere – including for an anal fissure (which medicine could not cure). I have also applied aloe vera AND honey directly into my eye and it had only a positive effect (although in my case this was unnecessary since the cause was unrelated to the eyes: it had to do with cheek muscles).

Aloe Meatal Catheterhttp://hunterurology.com/products/5-aloe-meatal-catheter– Clearly someone has already got the idea of using aloe vera as a coating for urinary stricture.

Note that there is a medicine alprostadil that is inserted into the meatus: See this (including diagrams). This video shows how it is done.

Overall it is evident that if done safely and with elimination of bacterial contamination, insertion of a small object into the meatus is safe.

 

Continue Reading

Stem cell treatment for post-prostate cancer surgery incontinence – but note there are potential severe risks associated with it

This is an amazing advance in science – BUT THERE IS A RISK THAT STEM CELL THERAPY MIGHT MULTIPLY ANY RESIDUAL CANCER CELLS THAT ARE LEFT BEHIND AFTER SURGERY.

“Decades ago, researchers discovered that a particular type of stem cell — mesenchymal stem cells — in bone marrow could generate new bone, cartilage, and fat. In 2001 researchers discovered that mesenchymal cells are even more plentiful in body fat…. Injured and inflamed cells send out an SOS signal; new stem cells pick it up. “The stem cells are so smart, all you have to do is turn them loose,” he offers. “They float around to different areas of the body and fix them.”…you’ll find a significant number of unhappy people who’ve paid thousands of dollars at clinics and have not seen any results. ?” [Source]

“Stem cells are able to be derived from a number of sources: embryonic stems cells (ESCs) and mesenchymal stem cells (MSCs) , which include: placental or amniotic fluid stem cells (AFPSCs), muscle-derived stem cells (MDSC) , adipose-derived stem cells (ADSC) , bone-marrow-derived stem cells, and even urinary-derived stem cells (USC).” [Urinary Continence and Sexual Function After Robotic Radical Prostatectomy]

Human trials in stress urinary incontinence have been ongoing for a number of years. Carr et al. reported on a patient population of 38 women with stress urinary incontinence who underwent muscle-derived stem cell injections into the sphincter. The women were also offered a second injection 3 months later. Ninety percent of the treated women had over a 50 % decrease in pad weight and only 50 % reported leaks. Adverse events were essentially absent [ 38 ].

Gotoh treated 11 men with persistent stress urinary incontinence 1 year after prostate surgery and demonstrated a 60 % decrease in urinary leakage volume on pads weighed by the patients. One of the 11 achieved complete return of urinary control. Functional urethral leak and urethral closing pressures were also increased compared to pretreatment levels. No adverse events were reported [39 ].

Currently, there is a large multicenter ongoing trial phase 3 trial in the United States with muscle-derived stem cells in women with stress urinary incontinence and a phase 1, 2 trial using muscle-derived stem cell in postpros-tatectomy incontinence (ClinicalTrials.gov Identifier: NCT01893138 and NCT02291432).

Although stem cells derived from any source are not yet ready for clinical use in men with stress urinary incontinence after radical retropubic prostatectomy, the future appears to hold promise. Nonetheless, ethical and regulatory issues remain of concern and may present hurdles to widespread clinical adoption [40 ].

The early ethical concerns surrounding the use of fetal embryonic stem cells have by and large been resolved by the development of so many other sources for multipotent stem cells. Nonetheless, the recent classification of stem cells as a “drug” places them under the purview of the FDA and now regulatory hurdles may enhance or impede the science and usefulness of these agents.

Finally, the fears of the development of secondary cancers or causing early recurrences/failures of cancers if stems cells are released into the operative field to and in early functional recovery are very real. Well-structured trials need to be carried out to address these questions and the questions of which (if any) of the currently available products might be best used in men undergoing prostatectomy. Nonetheless, the future of stem cells use in our patients undergoing prostatectomy appears bright.  [Urinary Continence and Sexual Function After Robotic Radical Prostatectomy]

Stem cells have been found to fix this issue by regenerating relevant tissue – THIS DOCTOR DOES IT. (Michell Kaye).

Male Incontinence and Cell Surgical Network is using Stromal Vascular Fraction with adipose derived adult mesenchymal stem cells to treat post prostatectomy incontinence. The SVF and a small amount of condensed fat matrix is injected with a telescope directly into a deficient sphincter under local anesthetic. Based on experience from Nagoya University, Japan where Stromal Vascular Fraction has been used successfully for male incontinence, we believe that the external sphincter may be regenerated to some extent to provide bladder control. can provide access to the same technology through our investigatory protocol. [Source]

“In the past five years, the number of U.S. stem cell clinics has mushroomed from 25 to 570, according to a recent report published in the journal Cell Stem Cell…. the costly procedures are still unapproved by the FDA, leaving an open gate for medical charlatans and hucksters.” [Source – including analysis]

“the FDA warns that stem cells can migrate to the wrong site or turn into tumors.” [source]

CLINICAL TRIALS IN AUSTRALIA

http://www.stemcellsaustralia.edu.au/About-Stem-Cells/trials-in-australia.aspx

PAPERS/REPORTS

Stem Cell Injections Ease Incontinence (2007) [“Endoscopic injections of human umbilical cord blood stem cells may be a safe treatment option for women with stress urinary incontinence (SUI), according to findings presented here at the American Urological Association annual meeting.”]

Stem Cell Therapy for Incontinence: Where Are We Now? (2011) What is the Realistic Potential?
Charuspong Dissaranan, Michelle A. Cruz, Bruna M. Couri, Howard B. Goldman, and Margot S. Damaser [” the future of this therapy looks promising”]

Stem Cells Treatment for the Local Urinary Incontinence After a Radical Prostate Cancer Surgery (2012) – clinical trial.

Stem cell injection successfully treats urinary incontinence (2012) [“The procedure means that today, she can do her strenuous morning exercises of standing broad jumps and stride jumps without having to wear heavy pads to absorb leakage.”

Stem Cell Therapy for Male Urinary Incontinence – Giberti C. · Gallo F. · Schenone M. · Cortese P. · Ninotta G. [“Regarding animal studies, bone marrow-, muscle- and adipose-derived stem cells have been widely studied, showing regeneration of the urethral sphincter and recovery of the damaged pelvic nerves. With regard to human studies, only four papers are available in the literature using muscle- and adipose-derived stem cells which reported a significant improvement in sphincteric function and incontinence with no severe side effects.”]

Pilot Study of Adipose Stem Cells in the Treatment of Urinary Incontinence (2014) [“ASC injection is a viable treatment strategy for female urinary incontinence.”]

Stem Cells May Ease Urinary Incontinence, Study Says (2014) [The study is published online in the July issue of the journal Stem Cells Translational Medicine.]

The potential role of stem cells in the treatment of urinary incontinence (2015) Christine Tran and Margot S. Damas [“Early clinical trials using stem cells for the treatment of stress urinary incontinence in both male and female patients have also achieved promising functional results with minimal adverse effects.”]

Stem Cell Therapy for Treatment of Stress Urinary Incontinence: The Current Status and Challenges
(2016) Shukui Zhou,1 Kaile Zhang,1 Anthony Atala,2 Oula Khoury,2 Sean V. Murphy,2 Weixin Zhao,2 and Qiang Fu1[“stem cell transplantation as a therapy for SUI has great promise”]

VIDEOS

Continue Reading

Policy issues identified after my experience with prostate surgery

I’ll pursue these after I’m better, but these are initial thoughts:

  1. While it would increase red tape, there should be ongoing regular monitoring of the progress of continence and erectile function for each such surgery. “The NHS – who make surgeons report their success rates these days – regard success after RP as using 1 pad or less per day by 12 months post-op.” – Source]

2. Patients should get a copy of the robotic prostate surgery video.

Doctors do get a copy of their surgery video record:

“I asked my doctor if he understands why some people have more severe incontinence problems and he said there is some correlation with age and fitness but that he’s reviewed the videos and records from his past surgeries and tried to correlate them with the outcomes but he still doesn’t understand the variations in outcome.” [Source].

This does imply, though, that the video might not do any good to an untrained patient. If even experts can’t use videos to predict continence outcomes then giving the videos to the patients may not help.

A full-fledged cost-benefit test should be applied in each case before any change is made to existing policy.

 

Continue Reading
Continue Reading
Continue Reading