Diseases of Prostate and Homeopathy

Dr.Satheesh Kumar.P.K BHMS,MD(Hom) Medical Officer, Dept. of Homoeopathy, Govt. of Kerala The common diseases affectin the prostate are !eni n hypertrophy of the prostate, carcinoma of the prostate and prostatitis. "rostatic calc#li and t#!erc#losis of the prostate are t$o other diseases rarely affectin the prostate. These conditions #s#ally occ#r in men over %& years of a e. Before dealin $ith the diseases of the prostate, $e m#st have an idea a!o#t the str#ct#re of prostate land. "rostate is an accessory land of male reprod#ctive system, $hich adds to the !#l' of the seminal fl#id. ((t is p#rely a enital or an) this is evinced !y the fact that in animals manifestin a seasonal se*#al life, the or an is r#dimentary e*cept d#rin r#ttin season. The normal ad#lt prostatic epitheli#m #nder oes atrophy after castration) "rostate resem!les an inverted cone and is firm in consistency, $hich lies !elo$ the nec' of the #rinary !ladder and s#rro#ndin the commencement of male #rethra. (t lies !ehind the lo$er part of p#!is symphysis and in front of rect#m. Size: +!o#t , cm across the !ase ($idth) -cm vertically ape* to !ase (len th) and . cm antero/posteriorly (thic'ness) 0ei ht1 +!o#t 2 m. +pe*1 Directed do$n $ards !et$een the medial mar ins of the levator ani m#scle. Base1 Directed #p$ards and is str#ct#rally contin#es $ith the nec' of !ladder. Surface: Four surfaces +nterior s#rface lies .cm !ehind the p#!ic symphysis $ith retro p#!ic fat intervenin . (ts #pper part is connected to p#!ic !one !y p#!o/ prostatic li aments and the lo$er end is pierced !y the #rethra. "osterior s#rface1 Trian le in shape. ,cm from the an#s and can !e easily palpated on di ital e*amination thro# h the rect#m. 3ear its #pper !order it is pierced on each side of the median plane !y the e4ac#latory d#ct. (nferio/lateral s#rfaces1 5elated to anterior fi!ers of levator ani. Lobes1 The #rethra and e4ac#latory d#ct traverse the prostate and divide it into % lo!es. +nterior lo!e1 / is a small isthm#s connectin the t$o lateral lo!es in front of #rethra. (t contain little or no land#lar tiss#es and there for seldom forms an adenoma "osterior lo!e1 connects the t$o lateral lo!es !ehind the #rethra. +denoma never occ#rs here. B#t the "rimary carcinoma is said to !e in in this part. Median lo!e1 lies !ehind the #pper part of the #rethra and in front of the e4ac#latory d#ct and 4#st !elo$ the nec' of the !ladder. (t contains m#ch land#lar tiss#es and is common site of adenoma. 6ateral lo!e1 lie on each side of the #rethra. (t contains eno# h of land#lar tiss#es, $hich may form an adenoma in old a e. Capsule: "rostate has a thin caps#le of fi!ro m#sc#lar tiss#es (tr#e caps#le) !#t is also enclosed in a loose sheath of visceral pelvic fascia (false caps#le), $hich is separated from the caps#le at the front and sides !y prostatic veno#s ple*#s. Histolo y: sho$s t$o $ell defined concentric 7ones separated !y an ill/defined irre #lar caps#le. The 7ones are a!sent anteriorly. O#ter lar er 7one is composed of lar e !ranched land. This is the e*cl#sive 7one for carcinoma. (nner smaller 7one composed of s#!m#cosal lands and a ro#p of short simple m#cosal lands s#rro#ndin the #pper part of the #rethra. This 7one is typically prone to !eni n hypertrophy of prostate d#e to

oestro enic stim#lation. Blood supply: Branches from inferior vesical, middle rectal and internal p#dental artery. (8alve less comm#nication !et$een the prostatic and verte!ral veno#s ple*#s e*ists thro# h $hich the prostatic cancer can spread to verte!ral col#mn and the s'#ll.) Lymphatic draina e: (n to the internal illiac and sacral nodes. "artly in to the e*ternal illiac nodes. !er"e supply: Both sympathetic and "ara sympathetic nerve. Prostatic secretion: is $atery opalescent fl#id, $hich contain acid phosphatase and protein. (t is dischar ed into the #rethra !y contraction of the m#sc#lar stroma at e4ac#lation. 9n7ymes that split or anic phosphates are present in many h#man tiss#es, !#t their concentration in the ad#lt prostate is several h#ndred times reater than in any other or an or tiss#es. (This hi h level is not achieved #ntil after p#!erty) B#!$%! #!L&'%#(#!) *F )H# P'*S)&)# Beni n enlar ement of the prostate #s#ally occ#rs in men over %& years of a e, most often !et$een :& and ;&. (+fter ,%/ %& years the prostate is either enlar ed (BH") or red#ced in si7e (Senile atrophy). These chan es are pro ressive till death.< (n (ndian, prostatic enlar ement is less fre=#ent and occ#rs more often in a yo#n er a e ro#p. )heories of causation: (t is #s#ally attri!#ted to the endocrine chan es of a in . Hormone theory1 +s a e advances the male hormone (andro en) diminishes $hile the =#antity of the oestro enic hormone is not decreased e=#ally. +ccordin to this theory the prostat-e enlar es !eca#se of predominance of oestro enic hormone. The prostatic enlar ement can !e re arded as invol#ntary hyperplasia d#e to dist#r!ance of the ratio and =#antity of the circ#latin andro ens and oestro ens. !eoplastic theory: "ost#lates that the enlar ement is a !eni n neoplasm >fi!romyoadenoma? @as the prostate is composed of fi!ro#s, m#sc#lar and land#lar tiss#es< Patholo y: The patholo ical chan es are confined to the inner 7one lands of lateral or middle lo!e or of !oth. This patholo ical chan es consists of an increase in n#m!er of lands @adenosis< and in their cell#larity @epitheliosis< and increase also in the amo#nt of fi!ro#s tiss#e in the stroma @Stromal proliferation< !et$een the lands, and there is formation of small cysts if the d#cts of the lands are !loc'ed. @The histolo ical chan es are closely resem!les those of fi!ro adenosis in the female !reast.< (f adenosis and cyst formation predominate, the inner 7one enlar es (sometimes to a remar'a!le e*tent) and this hypertrophied inner 7one compress the o#ter 7one of lands that forms a false caps#le. This false caps#le compresses, distorts and elon ates the prostatic #rethra, so that the o#t flo$ of #rine from the !ladder is o!str#cted. 0ith the prostatic hypertrophy, $hich o!str#cts the flo$ of #rine from the !ladder, secondary patholo ical chan es may occ#r in the !ladder, #reters and 'idneys. $n bladder these chan es consists of A.Tra!ec#lat(on/ hypertrophied !ands of m#scle fi!ers are formed inside the !ladder ..(nfection -.Stone and ,.divertic#la formation/there is shallo$ depression @'no$n as sacc#lation< in !et$een the hypertrophied m#scle fi!ers of the !ladder. Some times one of the sacc#les (rarely t$o or

more) contin#es to enlar e and forms a divertic#l#m. +pper urinary tract , A. Dilatation of #reters and pelvis /ca#sed !y !ac' press#re. .. (nfection and -. Stone. Kidney, A.Bhronic renal fail#re. Clinical features Blinical feat#res of !eni n hypertrophy of prostate are those of o!str#ction to the o#t flo$ of #rine from the !ladder and these are varia!le accordin to the lo!es affected. Fre-uency is the earliest symptoms especially at ni ht. @Cs#ally commencin at . or a.m.< (ncrease fre=#ency of mict#rition is d#e to inade=#ate emptyin of the !ladder and d#e to presence of sensitive prostatic m#c#s mem!rane of the intravesical enlar ement of the prostate. The fre=#ency !ecomes pro ressive and is then present !oth !y ni ht and !y day. +r ency d#e to the fact that #rine escapes thro# h the stretched vesical sphincter in to sensitive prostatic m#cosa @empty prostatic #rethra<, $hich ca#ses refle* for intense desires to void. Difficulty in mict#rition // Diffic#lty in startin mict#rition. He m#st $ait patiently for #rination to start. Strains hinder the flo$ rather than increasin the flo$. The stream is $ea' and dri!!les do$n instead of !ein pro4ected. "atient sho#ld !e as'ed $eather strains improve the streams (as in #rethral strict#re) or retard the stream/ (enlar ed prostate.) 9nlar ement of median lo!e not only pro4ects in to the !ladder !#t also forms a sort of valve over the internal #rethral orifice. So that the more the patient strain the more does it o!str#ct the passa e. Crine passes $hen the patient rela*es. &cute retention of urine,/ "atient has an #r ent desire to mict#rate !#t is #na!le to do so and the !ladder is distended, tense and tender. +c#te retension of the #rine may !e the first symptoms compel the patient to see' releaf !eca#se of the intense pain it prod#ces. Postponement of micturation. ind#l ence in alcoholic li=#ors partic#larly $hen he oes o#t of doors on a cold ni ht and confinement to !ed on acco#nt of some interc#rrent illness or operation are common precipitatin ca#ses of ac#te retension of #rine. Chronic retention $ith over flo$// 9ach time the patient mict#rates the evac#ation is incomplete and the !ladder rad#ally !#t pro ressively distends. The patient may !e #na$are that his !ladder is distended !#t #s#ally complains that he has little control over the small =#antities of #rine, $hich overflo$ do$n the #rethra at fre=#ent intervals. 3oct#rnal en#resis sho#ld !e a $arnin si n. Bhronic retension indicates severe and prolon ed o!str#ction and is often associated $ith dilatation of #pper #rinary tract, vesico/ #riteric refl#*, infection and chronic renal fail#re. Stream is varia!le, often $ea', tendin to stop and start and dri!!les to$ards the end of mict#rition. "ain occ#rs $ith cystitis or ac#te retension of #rine. 0hen hydronephrosis commences there may !e a d#ll pain in the loins. + feelin of $ei ht in the perine#m, or f#llness in the rect#m is occasional complaints. 5ec#rrent or persistent infections and stones in the !ladder and sometimes in the 'idneys. Haemat#ria or #rethral !leedin may occ#r $hen the prostate land is con ested and sometimes is the only symptoms of prostatic hypertrophy. Occasionally alarmin haemat#ria occ#rs from a r#pt#red prostatic vein or from erosion on the enlar ed prostate itself. Bhronic renal fail#re// The patient present himself $ith si ns of chronic renal fail#re.

Secondary effects of prostatic enlar ement +rethra: , The portion of #rethra lyin a!ove the er#montan#m !ecomes elon ated, sometimes to as m#ch as t$ice its normal len th. The canal is compressed laterally so that it tends to !ecome an antro/posterior slit. (8er#rnontan#m / a median lon it#dinal rid e of m#c#s mem!rane present on the posterior $all of prostatic #rethra / also 'no$n as #rethral crest< Bladder: / The m#sc#lat#re of the !ladder hypertrophies to overcome the o!str#ction. 0hen the middle lo!e pro4ects #p$ards in to the !ladder it acts as a dam to the last o#nce of #rine, $hich remains in the prostatic po#ch. Balc#li are prone to form in this sta nant pool of #rine. Tra!ic#lations, sacc#lations and divertic#l#m formation are also may fo#nd in the !ladder. The enlar ed prostate may compress the prostatic veno#s ple*#s) the res#ltin con ested veins (vesical piles) at the !ase of !ladder are apto ca#se haemat#ria. Cnless the o!str#ction is relieved a time is reached $hen !ladder hypertrophy ives place to atony. The tired m#scle ma'in no attempt to overcome the o!str#ction. +reters and Kidneys: , (ncreasin intravesical press#re or in some cases direct press#re of the intravesical portion of the prostate on the #reteric orifices ca#ses rad#al dilatation of #reters, follo$ed !y some de ree of !ilateral hydronephrosis. 0hen !ladder hypertrophy $anes the sphincter mechanism aro#nd the #reteric orifices ceases to f#nction permittin refl#* of #rine from the !ladder in to the dilated #reters $ith increasin dama e to the renal parenchyma. +s a res#lt of ascendin infection ac#te or chronic pyelonephritis s#pervenes. Se*#al or ans1 / (n the early sta es of prostatic enlar ement there is increased li!ido. 6ater impotence is the r#le. #/aminations A. 9*amination of the a!domen/ O!str#ction to the o#t flo$ of #rine from the !ladder $ill !e fo#nd on palpation, perc#ssion and sometimes on inspection $ith loss of the transverse s#pra/p#!ic s'in crease. The renal areas sho#ld !e palpated for tenderness and possi!le enlar ement of the 'idneys. .. 9*amination of the ton #e/ Dry !ro$n ton #e and #rine of lo$ specific ravity indicate renal ins#fficiency. -. 9*amination of #rinary meat#s/ to e*cl#de stenosis. ,. 5ectal e*amination/ Dindin s on rectal e*amination vary dependin on $hich lo!e or lo!es of the prostate are involved. (f the lateral lo!es are involved the prostate feel lar e and smooth, is elastic and #niform in consistence and mo!ile (f the middle lo!e alone is affected, the prostate feels normal on e*amination !eca#se an enlar ed middle lo!e pro4ects for$ards into the rect#m and can !e reco ni7ed only !y cystoscopy. 5esid#al #rine may !e felt as a fl#ct#atin s$ellin a!ove the prostate. (t sho#ld !e noted that if there is considera!le amo#nt of resid#al #rine present, it p#shes the prostate do$n$ards ma'in it appear lar er than it is. %. 0hen possi!le, the act of mict#rition sho#ld !e $atched. 6oss of pro4ectile po$er is si nificant. :. + mid stream specimen of #rine sent for !acteriolo ical e*amination. ;. 3ervo#s system e*amination/ to eliminate ne#rolo ical lesion. Dia!etes mellit#s Ta!es Disseminated sclerosis Bervical spondylosis may ive symptoms that mimic prostatic "ar'insonEs disease and o!str#ction

Other ne#rolo ical states 2. The mict#ro raphF+ raphic recordin of patients stream rate and vol#me of the #rine can !e o!tained and is most helpf#l in determinin the de ree of o#tflo$ o!str#ction. G. 9*amination of !lood a< Blood #rea !< Blood co#nt !ein essential. c< Serolo ical test for syphilis. A&. 9*amination of #rine/ a< Dor evidence of infection !< B#lt#re c< Test for the presence of l#cose. AA. (ntraveno#s #ro raphy/ it has !een the tradition to perform an intraveno#s #ro raph $hen investi atin patients $ith !ladder o#t flo$ o!str#ction. The plaine film may sho$ the presence of a calc#l#s $hether in the 'idney or in the !ladder. (t $ill also sho$ if there is de enerative disease of the l#m!ar spine and sometimes the characteristics feat#re of a sclerotic !ony metastasis from carcinoma of the prostate. (t $ill sho$ the conto#r of the !ladder and $hether tra!ic#lation, sacc#lation or a divertic#l#m is present. + film after mict#rition reveals si nificant resid#al #rine. A.. Cltra so#nd e*amination A-.Crodynamics/ $hen a clear dia nosis has not !een reached or if ne#ropathy is s#spected an #rodynamic investi ation can #s#ally esta!lished $hether !ladder o#t flo$ o!str#ction is present. @The principle is artificially sim#late !ladder fillin and emptyin $hilst o!tainin scientific meas#rement of the vario#s f#nctions involved< 5ecordin of the resid#al vol#me, the intravesical press#re, the !ladder capacity and the sensation of f#llness can all !e o!tained =#ite simply. A,. Bysto #rethroscopy/ inspection of the #rethra, the prostate and #rotheli#m of the !ladder sho#ld al$ays !e made !efore prostatectomy. (t !eein important to e*cl#de the presence of #rethral strict#re, a !ladder carcinoma and the occasional non/radio opa=#e vesical calc#l#s. A%. Batheteri7ation and resid#al #rine/ (ntrod#ction of a catheter may determine the type of o!str#ction in #rethra. 0ith an enlar ed prostate o!str#ction is enco#ntered after the catheter has one !eyond the ape* of the prostate d#e to 'in'in of prostatic #rethra. 5esid#al #rine @amo#nt of #rine collected !y means of a catheter after the patient has voided #rine< is a ood indication of the capacity of the retro/ prostatic po#ch partic#larly in case of prostatic enlar ement. )reatment Beni n hypertrophy of prostate is treated not !eca#se the land is lar e !#t !eca#se it is ca#sin o!str#ction. There is no correlation !et$een the si7e of the prostate assessed !y rectal e*amination and the de ree of o!str#ction. Medical treatment may red#ce the con estion in the land, control infection and improve renal f#nction and patientEs eneral condition. +c#te #rinary retention is distressin and painf#l. (t re=#ires decompression of the !ladder !y the passa e of a #rethral catheter. Bhronic #rinary retension, $hich is painless, and havin no symptoms s# estive of coe*istent infection and $ith the normal ser#m creatinie level do not necessarily re=#ire a catheter. Craemic patient $ith chronic retension are often dehydrated at the time of admission. D#e to the chronic !ac' press#re on the distal t#!#les $ithin the 'idney, loss of their a!ility to rea!sor! salt and $ater. Then there is enormo#s o#t flo$ of salt and $ater, $hich has !ecome 'no$n as a post o!str#ctive di#resis. (ntraveno#s fl#id replacement is re=#ired if the patient is #na!le to 'eep #p $ith this fl#id loss.

*perati"e treatment $ndication for operation: A. "rostatism/ @fre=#ency, #r ency and diffic#lty of mict#rition< prostatectomy is advised. . .+c#te retension/ $hich is #nrelieved !y passin a catheter. -. Bhronic retensionF a resid#al #rine of .&& ml or more. ,. Bomplication/ stone, infection and divertic#l#m formation. %. Haemorrha eF veno#s !leedin from a r#pt#red vein overlyin the prostate $ill not stop $ith catheter draina e. So prostectomy m#st !e performed. "rostactomy or more correctly the removal of the adenomato#s hyperplasla, !y one of the fo#r ro#tes is practica!le in the reat ma4ority of cases. )he prostate can be approached A.Thro# h the !ladder @transvesical< . 5etro p#!ically -.Drorn the perine#m ,.Trans #rethrally @TC5", "C5"F Trans #rethral or pre #rethral resection of prostate.< Trans#rethral resection of prostate has lar ely replaced other methods #nless divertic#lectomy or the removal of lar e stones necessitates open operation. Complication of operation: / A 6ocal and . General 6ocal complication Haemorrha e is the most tiresome complication follo$in prostatectomy $hatever s#r ical approach. Secondary haemorrha e tends to occ#r aro#nd the tenth postoperative day and is #s#ally associated $ith the patient overe*ertin himself or the presence of #rinary infection. "erforation of the !ladder or the prostatic caps#le can occ#r. (nfection in the !ladder, epididymis or 'idney. (ncontinence is inevita!le if the e*ternal sphincter mechanism is dama ed. 5etro rade e4ac#lation and impotence// +ll patients havin a prostatectomy sho#ld !e $arned that they are li'ely to s#ffer from retro rade e4ac#lation. @This occ#rs once the !ladder nec' is rendered incompetent.< Strict#re may occ#r secondary to prolon ed catheteri7ation. Bladder nec' contract#re d#e to the over #se of the coa #latin diathermy. %eneral complication: , Bardio vasc#lar system/ p#lmonary atelectasis, pne#monia, myocardial/ infarction con estive cardiac fail#re and deep vein throm!osis. 0ater into*ication/ the a!sorption of $ater in to the circ#lation at the time of a trans/ #rethral resection can ive rise to con estive cardiac fail#re, hypo/ natraemia and haemolysis. Homoeopathic medicine +r ent#m nitric#m / 9mission of a fe$ drops after havin finished. Divided stream. "rof#se #rine and terri!le c#ttin pain. Bloody #rine. Crine passes #nconscio#sly day and ni ht. (mpotence. 9rection fails $hen coition is attempted. +loes soc/ #rinary incontinence in a ed. Bearin do$n sensation and enlar ed prostate. Scanty hi h colo#red #rine. Baryta car!/ Diseases of the old man $hen de enerative chan es !e in $ho have

hypertrophied prostate or ind#rated testis. 8ery sensitive to cold, offensive foot s$eats, very $ea' and $eary m#st sit or lie do$n or lean on somethin . Bhimaphila #m!ellata/ +cts principally on 'idneys and enito#rinary tract. "rostatic enlar ement/ m#st strain !efore flo$ comes. Scanty #rine. +c#te prostatis, retension and feelin of a !all in perine#m. Cna!le to #rinate $itho#t standin $ith feet $ide apart and !ody inclined for$ard. Crine t#r!id, offensive containin ropy or !loody m#c#s and depositin a copio#s sediment. Derr#m picric#mF is considered a reat remedy to complete the action of other medicine. Senile hypertrophy of the prostate. "ain alon entire #rethra. Dre=#ent mict#rition at ni ht $ith f#ll feelin and press#re in rect#m. Smartin at nec' of !ladder and penis. 5etonsion of #rine. Hydran eaF + remedy for ravel, prof#se deposit of $hite amorpho#s salts in #rine. B#rnin in #rethra and fre=#ent desire. Crine hard to start. Great thirst $ith a!dominal symptoms and enlar ed prostate. "op#l#s trem#loides/ Batarrh of the !ladder especially in old people. Good remedy in vesical tro#!les after operations. Severe tenesm#s. "ainf#l scaldin . "rostate enlar ed. "ain !ehind p#!is at end of #rination. Sa!al aerr#lataF Has #n=#estioned val#e in prostatic enlar ement, epididymitis and #rinary diffic#lties. +cts on mem!rano/prostatic portion of #rethra. (ritis $ith prostatic tro#!le. Dear of oin to sleep. Desire for mil'. Bonstant desire to pass $ater at ni ht. Bystitis $ith prostatic hypertrophy. Dischar e of prostatic fl#id. Boit#s painf#l at the time of emission. Senecio a#re#s/ Has mar'ed action over the #rinary or ans. Scanty hi h colo#red #rine $ith m#ch m#c#s and ten#sm#s. Great heat and constant #r in . D#ll heavy pain in spermatic cord e*tendin to testicles. Solida o vir a F Crine scanty, reddish !ro$n, thic' sediment, dys#rea, ravel. Diffic#lt and scanty. Blear and offensive #rine. Some times ma'e the #se of catheter #nnecessary S#lph#r/ Dre=#ent mict#rition especially at ni ht. B#rnin in #rethra d#rin mict#rition lasts lon after. "arts sore over $hich #rine passes. M#st h#rry, s#dden call to #rinate. Great =#antities of colo#rless #rine. Thiosinamin#mF 9nlar ed lands. Th#ia/ Crinary stream split and small. Dre=#ent mict#rition accompanyin pains. Sensation of tric'lin after #rinatin . Severe c#ttin after. Desire s#dden and #r ent !#t can not !e controlled ."ain and !#rnin felt near nec' of !ladder $ith fre=#ent and #r ent desire to #rinate. Thyroidin#mF (ncreased flo$ of #rine. "oly #rea. Desire for s$eets and thirst for cold $ater. 0orse ridin in car. Be#7oic#m acid#m// Hi hly col#red and very offensive #rine. Balcarea fl#rica// Dor hard stony lands. Balcarea iodataF Scrof#lo#s affections, especially enlar ed lands. Boni#m macF +cts on land#lar systemFen or in and ind#ratin it. +lterin its str#ct#re li'e scrof#lo#s and cancero#s conditions. M#ch diffic#lty in voidin #rine. (t flo$s and stops a ain. Dri!!lin in old men. (od#m F Dre=#ent and copio#s dar' yello$ reen. 6ycopodi#m H Crine slo$ in comin , m#st strain. 5etension. "oly#rea d#rin the ni ht. "areira !ravaF#sef#l in renal colic, prostatic affections and catarrh of !ladder. Bonstant #r in , reat strainin can emit #rine only $hen he oes on his 'nees pressin head firmly a ainst the floor. Dri!!lin after rnict#rition. Crethritis $ith prostatic tro#!le. "icric#m acid#m / "rostatic hypertrophy, especially in cases not too for advanced. Dri!!lin mict#rition. 3i htly #r in . "#lsatillaF (ncreased desire $orse $hen lyin do$n. (nvol#ntary #rination at ni ht $hile co# hin . +c#te prostatitis. "ain and tenesm#s in #rinatin $orse lyin on !ac'. SarasaprillaF Severe pain at concl#sion of #rination. Crine dri!!les $hile sittin .

Staphysa ria/ "rostatic tro#!les. Dre=#ent #rination, !#rnin in #rethra $hen not #rinatin #p on !ladder, feels as if it did not empty as if a drop of #rine $ere rollin contin#o#sly alon the channel. Gelsemi#mF GraphitisF Hepar s#lph/ Crine voided slo$ly $ith o#t force/ drops vertically seems as if some al$ays remained. Bladder diffic#lties of old men. Kali !ich/ +fter #rinatin a drop seems to remain, $hich cannot !e e*pelled. Bhromi#m s#lphateF 9#patori#m p#rp#re#m/ +l!#min#ria, dia!etes mellit#s, stran #ry, irrita!le !ladder, and enlar ed prostate are a special fe#d for this remedy. Bonstant desire / !ladder feels d#ll. ('sh# anda (Tri!#l#s terrestris)/ Csef#l in #rinary affection, especially dys#rea, prostatitis and calc#l#s affection. Ole#m santali (Oil of sandal $ood)// Stream small and slo$. Sensation of a !all pressin a ainst the #rethra. 0orse standin . O*ydendrnF "rostatic enlar ement, vesical calc#li. (rritation of nec' of !ladder. "iper methystic#m ('ava 'ava)// Crinary and s'in symptoms have !een verified. Bystitis. 5h#s aromaticaF 5enal and #rinary affection. Senile incontinence. Severe pain !efore or at !e innin of #rination. Bonstant dri!!lin . Tritic#m (+ ropyron repens)// Dre=#ent, diffic#lt and painf#l #rination, incontinence and constant desire. Medorrhin#mFpainf#l tenesm#s $hen #rinatin . Crine flo$s very slo$ly. 9nlar ed and painf#l prostate $ith fre=#ent #r in and painf#l #rination. C&'C$!*(& *F P'*S)&)# Barcinoma of the prostate is the common mali nant condition in men over the a e of :% years. +!o#t .&I of cases of prostatic o!str#ction prove to !e d#e to carcinoma. (t is less common in Japanese $hile its incidence is hi her and its !ehavior is more a ressive in +merican 3e roes. Barcinoma of prostate, $hich is an adeno/carcinoma, starts on the o#ter 7one lands of a normal or hypertrophied prostate and may occ#r in the false caps#le deli!erately left !ehind after prostatectomy for !eni n hypertrophy. So prostatectomy for !eni n hypertrophy of land confers little protection from the s#!se=#ent development of carcinoma. Histolo ical appearance "rostate is a land#lar str#ct#re consistin of d#cts and acini, there for histolo ical pattern is one of an adeno/carcinoma. + layer of myoepithelial cells s#rro#nds the prostate lands. The first chan e associated $ith carcinoma is the loss of this layer $ith the lands appearin in confl#ence. +s the cell type !ecomes less differentiated more solid sheets of carcinoma cells are seen. Local spread + ro$th commencin in the posterior 7one of the land is prevented from e*tendin !ac'$ards !y the stron t#nica of Denovilliers. Bonse=#ently it tends to ro$ #p $ards to involve the seminal vesicle. D#rther #p$ards e*tension o!str#cts the lo$er end of one or !oth #retersF the latter terminatin in an#ria. Barcinoma commencin in a lateral lo!e involves the prostatic #rethra early. (n advanced cases the !ase of the !ladder is invaded. The rect#m may !ecome stenosed !y ro$th infiltratin ro#nd it. B#t direct involvement is very late. Spread !y !lood stream Occ#rs partic#larly to !ones .The "rostate is the most common site of ori in for s'eletal metastasis (!ein follo$ed in t#rn !y the !reasts, the 'idney, the !ronchial tree and the thyroid land). The !ones most fre=#ently involved are pelvic !ones and the lo$er l#m!ar

verte!rae. Demoral head, ri! ca e and s'#ll are other favo#red sites. The fre=#ent pro*imity of s'eletal metastases to the primary ro$th has !een attri!#ted to reversed flo$ from the vesical veno#s ple*#s to the emissary vein of the pelvic !one d#rin co# hin , snee7in etc. Bony metastases appear in */ray as sclerotic areas. Lymphatic spread Thro# h the lymphatic vessels passin alon the sides of the rect#m to the lymph nodes alon the internal iliac vein $hich lies in the hollo$ of the sacr#m. Thro# h lymphatic $hich pass over the seminal vesicles and follo$ the vas deference for a short distance to drain in to e*ternal illiac node. Drom !oth this sit#ation the retroperitoneal lymph node, later the mediastinal lymph node and occasionally the s#praclavic#lar lymph node !ecome affected. CL$!$C&L F#&)+'#S: Barcinoma prostate #s#ally occ#rs in older man. Symptoms are very similar to !eni n hypertrophy of prostate. (Dre=#ency, #r ency and diffic#lty of mict#rition.) B#t the main difference is that the history is =#it short and they et $orse rapidly. (ncontinence a short history of #p to : month and pain on mict#rition are s# estive feat#res of carcinoma in a patient $ith history of prostatism. &ccordin to the pro ression of disease0 it can be classified in to 1 types. Type A1 Discovered only on histolo ical e*amination of tiss#e removed at prostatectomy. Type .1 5ectal findin s of a hard nod#le or e*tension o#tside the caps#le, investi ated !y perineal !iopsy. Type -1 The primary may !e tiny and occ#lt, the patient presentin $ith the rhe#matism or arthritis $ith !lood acidphosphatase level often very hi h. Crinary symptoms are a!sent or sli ht. The prostate specific anti en ("S+) is hi h. Type ,1 "ain in the !ac' or sciatica is the main symptoms. Bilateral sciatica in an elderly man is most often d#e to metastases in the spine from a carcinoma of the prostate. Oedema of one or either le s, paraple ia or a spontaneo#s fract#re is occasionally d#e to metastases from a carcinoma of the prostate. +naemia may !e the presentin symptoms. On acco#nt of destr#ction of !one marro$, !one metastases from carcinoma of prostate can ive rise to a haernorrha ic diathesis and the patient s#ffers haernorrha e often severe, not necessarily from the #rinary tract. (f the mali nant land o!str#cts the #rethra, the patient complaints of diffic#lties in mict#rition, #rinary retension, infection, stones or renal fail#re. ((ndistin #isha!le from those ca#sed !y !eni n hypertrophy of prostate) Beca#se carcinoma !e ins in o#ter 7one lands, it only o!str#ct the #rethra $hen it is locally advanced and some patient have no #rinary symptoms !#t they have pain in !ac' or sciatica ca#sed !y !ony metastases. 'ectal e/amination: Biman#al e*aminations #nder anesthesia, to ether $ith cystoscopy and needle !iopsy are essential in order to assess the local sta e of ro$th. (rre #lar ind#rations $ith stony hardness in part or in the $hole of land $ith o!literation of the median s#lc#s s# ests carcinoma . )!( ,Classification 2adopted by the international union a ainst cancer3 This is a detailed clinical sta in , $hich is arrived at simply !y the clinician ascertain the follo$in points d#rin his e*amination of the patient. A. 0hat is the e*tent of the primary t#rnerK .. +re there any lymph node affectedK -. +re there any metastasesK

TCMOC5 3OD9S M9T+ST+S9S T.O/ Blinically #ns#spected 3. &/ 3o evidence of involvement of re ional lymph node M.&/ 3o evidence of distant metastases T. A/ 6ocal nod#le 3. A/ (nvolvement of one re ional lymph node. M. A/Distant metastases. T../Dif#se or deformin caps#le. 3../ (nvolvement of several re ional node. T.-/O#t side caps#le or e*tension in to vesicle 3.-/ Di*ed mass of re ional lymph node T.,/ Di*ed to the other tiss#e. 3.,/ (nvolvement of common illiac or "ara/aortic node $!4#S)$%&)$*! Blood1 Hemo lo!in percenta e (6e#coerythro!lastic anaemia secondary to e*tensive marro$ invasion or anaemia may !e secondary to renal fail#re) "latelet co#nt1 "latelet co#nt sometimes red#ced $hen metastases present. 5enal f#nction test1 Beca#se hydronephrosis may e*ists from chronic !ladder o#t flo$ o!str#ction or from direct invasion of one or !oth of the #reters !y the carcinoma. 6iver f#nction test1 +!normal $hen there is e*tensive metastatic invasion of the liver. +l'aline phosphatase may !e raised from hepatic involvement or from secondaries in the !one. +cid phosphatase1 "rostatic fraction can !e meas#red !y an en7yme techni=#e or a radio imm#no assay. + raised val#e is stron ly s# estive of prostatic carcinoma. .& I of patient $ith metastases $ill have a normal val#e. So it is not a ood screenin test. "rostatic specific anti en1 Meas#rement of prostatic specific anti en is no$ tho# ht to have reat specificity $hen loo'in for a response to treatment. 5adiolo ical1 L/ray chest/ metastases in the l#n fields or the ri!s. +!dominal L/ray / sclerotic metastases too commonly in the l#m!ar verte!ra and pelvic !ones. Cltrasono raphy1 Transrectal #ltraso#nd helpf#l in sta in local disease. Bone scan1 +chieved !y the in4ection of techneti#m GG the isotope is then monitered #sin a amma camera. 6ymphan io raphy1 +ssessment of lymph nodes in the pelvis can !e performed !y lyraphan io raphy. Bone marro$ aspiration1 5eveal the presence of metastatic carcinoma cells. Biopsy1 Csin a 8in Silverman needle transrectally can !e done if the dia nosis ii in do#!t. )'#&)(#!) Sur ery: A. Trans #rethral resection (TC5) TC5 is done in the presence of o#t flo$ o!str#ction. This $ill ive material for dia nosis and provide symptomatic relief. TC5 may not remove all the local cancer. (t may !e appropriate if the !one scan is normal. .. 5adical prostatectomy 5adical prostatectomy commonly res#lts in total #rinary incontinence and loss of potency. -. "elvic lymph node dissection and A/A-A seed implantation + pelvic lymph node desection $ith fro7en section e*amination is performed. ( A-A seeds are then implanted into the prostate ass#min the nodes are free of t#mor. This techni=#e

delivers a hi h dose of radiotherapy $ith lo$ penetration. ,.Orchidectomy Bilateral orchidectomy $ill eliminate the ma4or so#rce of testosterone prod#ction %. Hypophysectomy and adrenalectomy 3ot #sed in no$/a days. 'adio therapy1 6ocal1 5adical radiotherapy to the prostatic !ed and pelvic lymph node. 6ocal complication are inevita!le/ namely irritation of !ladder, #rinary fre=#ency, #r ency and some times #r e incontinence. Some #pset to rect#m $ith diarrhoea H occasionally late radiation prosatitis. General1 radiotherapy for symptomatic metastases is a e*cellent form of treatment often prod#cin dramatic pain relief. D'+% )'#&)(#!) 2H*(*#*P&)H$C3 Barcinocine . "l#m! met S#lph#r Boni#m mac "sorin#m Th#4a Brot. hor (pain $ith) Seleni#m Silicea Bop Sence , (od#m P'*S)&)$)$S &cute prostatitis is #s#ally seen in men !et$een the a es of -& and %&. (n !oth ac#te and chronic prostatitis the seminal vesicles and the prostatic #rethra are also #s#ally involved. Then there is a triad of patholo ical condition namely posterior #rethritis, prostatitis and seminal ves(c#litis. +c#te prostatitis is a common clinical condition seen in o#r day today practice. &#)$*L*%5 The #s#al or anism responsi!le is 9. coli. B#t staphylococc#s a#reas and al!#s, streptococc#s faecalis and the onococc#s may !e responsi!le. The infection is haemato eno#s from a distant foc#s nota!ly f#r#nc#losis, infected tonsils, caries teeth or divertic#litis. (n a minority of cases, the infection ascends from the #rethra or descends from the !ladder or 'idney. CL$!$C&L F#&)+'#S (nfection #s#ally !lood !orne. General manifestations are/ the patient feels ill, shivers, may have ri or, achin all over, especially the !ac'. The temperat#re may !e #p to -G/c. "ain on mict#rition is #s#al. "erineal heaviness, rectal irritation and pain on defecation may occ#r and sittin may !e #ncomforta!le. Dre=#ency occ#rs $hen the infection spreads #p to the !ladder. 5ectal e*amination/reveals a tender prostate and the seminal vesicle may !e involved. CH'*!$C P'*S)&)$)$S +etiolo y1 is a se=#el of inade=#ately treated ac#te prostatitis. Smears sho$ !acteria in a!o#t ,&I and c#lt#res are positive in ;&I of cases. The predominant or anisms are 9. coli, Staphylococc#s, streptococc#s and Diphtheroids in that order. Trichomonas has !een fo#nd to !e a ca#se of chronic prostatitis (and may !e common to !oth h#s!and and $ife) Bhlamydia is another ca#sative or anism. "+THO6OGM 6#men of the d#cts !ecomes !loc'ed $ith epithelial de!ris and p#s. This ca#ses a soft enlar ement of the or an. 6ater fi!rosis occ#rs, and the prostate !ecomes smaller and harder.

CL$!$C&L F#&)+'#S A. Ba#sin chronic posterior #rethritis/ specimen sho$s %& or more p#s cellsN H"D. .. Ba#sin epididymitis -. "ain/ 6ocal pain (d#ll ache) in the perine#m and rect#m. + ravated !y sittin on a hard chair. 5eferred pain/ 6o$ !ac' ache, l#m!a o, some times e*tendin do$n the le . ,. Silent prostatitisF "#s has !een o!tained from the prostate. 3o other symptoms. (B#t patient may have arthritis, myositis, ne#ritis and sometimes iritis and con4#nctivitis.) %. 5ec#rrin attac's of mild pyre*ia. :. Se*#al dysf#nctionF "remat#re e4ac#lations, prostatorrhoea and impotence. D$&%!*S$S A. + -/ lass #rine test/ (f the first lass sho$s #rine containin prostatic threads, prostatitis is present. .. 5ectal e*amination/ May or may not confirm the dia nosis. -.9*amination of the prostatic fl#id/ O!tained !y prostatic massa e. (3ormal prostatic fl#id is sli htly opalescent and viscid.) May sho$ many p#s cells and sometimes !acteria. ,. CrethroscopyF 5eveals inflammation of prostatic #rethra. )'#&)(#!) +c#te prostatitis1 +voidance of alcohol and se*#al interco#rse for si* $ee' is $ise. H*(*#*P&)H6C (#D$C$!# +conite +esc#l#sF Dischar e of prostatic fl#id at stool. Dre=#ent, scanty, dar' and hot #rine. +pis mel Belladonna Bryonia Bantharis// (ntolera!le #r in O tenesrn#s, #rine scald him Ois passed drop !y drop. Bonstant desire to #rinate. Bhimaphilla Bolchic#m// Crine contain clots of p#trid decomposed !lood, al!#min O s# ar. Bopaiva F +ct po$erf#lly on m#c#s mem!rane especially that of #rinary tract t#r!id color. "ec#liar p#n ent odor. B#!e!a// P M#c#s mem!rane enerally especially that of the #rinary tract. "rostatis $ith thic' yello$ dischar e. Di italis F Bontin#ed #r in in drops dar', hot !#rnin s $ith sharp c#ttin pain at the nec' of !ladder as if a stra$ $as !ein thr#st !ac' O forth, ammoniacal O t#r!id #rine. Derr#m "hos Gelsemi#m Hepar s#lph (od#m Kali iod Merc cor Merc d#l 3itric acidFScanty dar' offensive smells li'e horse #rine. Bold on passin . +lternation of clo#dy phosphatic #rine $ith prof#se #rinary secretions in old prostatic cases. 3itr#m Oli#m santele "ichi (Da!iana im!ricta)//8esclcal cattarah $ith s#pp#rative prostatic condition. "icric acid "#lsatilla Sa!adilla

Sa!al .Ser Sali* ni raP Has a positive action on the enerative or ans of !oth se*es. Seleni#m Silicea Solida o Staphysa ria Th#4a Tritic#m 8erat .v 8esicaria CH'*!$C P'*S)&)$S +#rm me Baryta car! Brachy lottis Baladi#m Bar!oni#m s#lph Ba#stic#m Blematis Boni#m mac Derr#m "icric#m Graphitis Hepar s#lph Hydrocotyl (od#m 6ycopodi#m Merc cor Merc sol 3itric acid 3#* vomica "hytolacca "#lsatilla Sa!adilla Sa!ina Sepia Seleni#m Silicea Solida o Staphysa ria S#lph#r Th#4a Tri!#l#s

"5OST+T(B B+6BC6( T$o types A.9ndo eno#s1 Bommon F are #sally composed of calci#m phospahte pl#s .&I of or anic material .. 9*o eno#s1 5are// is a #rinary (#reteric) calc#l#s that !ecome arrested in prostatic #rethra.

CL$!$C&L F#&)+'#S Often symptomless, !ein discovered on L/ ray of pelvis for any other ca#se. Symptoms are at first those of chronic prostatis or prostatic o!str#ction. Treatment Small calc#li) Symptoms mild / Treatment of cNc prostatitis Trans #rethral resection 5etrop#!ic prostato lithotomy )+B#'C+L*S$S *F )H# P'*S)&)# T#!erc#losis of prostate and seminal vesicles associated $ith renal t#!erc#losis in at least :&I. (n -&I there is history of p#lmonary t#!erc#losis. 5ectal e*amination reveals one or more $ell defined nod#les most often near the #pper or lo$er !order of one or !oth lateral lo!e. CL$!$C&L F#&)+'#S Crethral dischar e is the first symptoms. "ainf#l sometimes !loodstained e4ac#lation (.& I). Mild ache in the perine#m. (nfertility (fertility very m#ch red#ced). 2&I are sterile. Crinary symptomsF 0hen the posterior #rethra !ecomes involved from e*tension of t#!erc#losis from the prostate/ there is painf#l, fre=#ent mict#rition and sometimes terminal haemat#ria. +!scess formation/ Bold a!scess formation in the prostate. (Sli htly tender soft s$ellin ) (t #s#ally r#pt#red in to the #rethra, rarely thro# h the perine#m or in to the rect#m. (f a rectoF prostatic fist#la develops it is e*tremely diffic#lt to heal even $hen the t#!erc#lo#s infection has !een eliminated. ((f a prostatic a!scess forms it is !etter to evac#ate it !y the perineal ro#te than to permit it to r#pt#re spontaneo#sly.) $!4#S)$%&)$*! 5adio raphyF lar e scattered area of calcification Bacteriolo ical e*amination of fl#id/ ives positive c#lt#re of t#!ercle !acilli. "osterior #rethroscopy/ reveals one or more dilated prostatic d#ct pl#s t#!ercle !acilli in the e4ac#late/ esta!lishes an a!sol#te dia nosis. )'#&)(#!) General and treatment for t#!erc#losis.