Diseases of Prostate and Homeopathy
Diseases of Prostate and Homeopathy
oestrogenic stimulation.
Blood supply: Branches from inferior vesical, middle rectal and internal pudental artery.
(Valve less communication between the prostatic and vertebral venous plexus exists
through which the prostatic cancer can spread to vertebral column and the skull.)
Lymphatic drainage: In to the internal illiac and sacral nodes. Partly in to the external
illiac nodes.
Nerve supply: Both sympathetic and Para sympathetic nerve.
Prostatic secretion: is watery opalescent fluid, which contain acid phosphatase and
protein. It is discharged into the urethra by contraction of the muscular stroma at
ejaculation. Enzymes that split organic phosphates are present in many human tissues, but
their concentration in the adult prostate is several hundred times greater than in any other
organ or tissues. (This high level is not achieved until after puberty)
BENIGN ENLARGEMENT OF THE PROSTATE
Benign enlargement of the prostate usually occurs in men over 50 years of age,
most often between 60 and 70. (After 45- 50 years the prostate is either enlarged (BHP) or
reduced in size (Senile atrophy). These changes are progressive till death.]
In Indian, prostatic enlargement is less frequent and occurs more often in a younger age
group.
Theories of causation:
It is usually attributed to the endocrine changes of aging.
Hormone theory: As age advances the male hormone (androgen) diminishes while the
quantity of the oestrogenic hormone is not decreased equally. According to this theory the
prostat3e enlarges because of predominance of oestrogenic hormone. The prostatic
enlargement can be regarded as involuntary hyperplasia due to disturbance of the ratio
and quantity of the circulating androgens and oestrogens.
Neoplastic theory: Postulates that the enlargement is a benign neoplasm
fibromyoadenoma [as the prostate is composed of fibrous, muscular and glandular
tissues]
Pathology:
The pathological changes are confined to the inner zone glands of lateral or middle lobe or
of both. This pathological changes consists of an increase in number of glands [adenosis]
and in their cellularity [epitheliosis] and increase also in the amount of fibrous tissue in the
stroma
[Stromal proliferation] between the glands, and there is formation of small cysts if the
ducts of the glands are blocked. [The histological changes are closely resembles those of
fibro adenosis in the female breast.]
If adenosis and cyst formation predominate, the inner zone enlarges (sometimes to a
remarkable extent) and this hypertrophied inner zone compress the outer zone of glands
that forms a false capsule. This false capsule compresses, distorts and elongates the
prostatic urethra, so that the out flow of urine from the bladder is obstructed.
With the prostatic hypertrophy, which obstructs the flow of urine from the bladder,
secondary pathological changes may occur in the bladder, ureters and kidneys.
In bladder these changes consists of
1.TrabeculatIon- hypertrophied bands of muscle fibers are formed inside the bladder
2.Infection
3.Stone and
4.diverticula formation-there is shallow depression [known as sacculation] in between the
hypertrophied muscle fibers of the bladder. Some times one of the saccules (rarely two or
Operative treatment
Indication for operation:
1. Prostatism- [frequency, urgency and difficulty of micturition] prostatectomy is advised.
2 .Acute retension- which is unrelieved by passing a catheter.
3. Chronic retension a residual urine of 200 ml or more.
4. Complication- stone, infection and diverticulum formation.
5. Haemorrhage venous bleeding from a ruptured vein overlying the prostate will not
stop with catheter drainage. So prostectomy must be performed.
Prostactomy or more correctly the removal of the adenomatous hyperplasla, by one of the
four routes is practicable in the great majority of cases.
The prostate can be approached
1.Through the bladder [transvesical]
2 Retro pubically
3.Frorn the perineum
4.Trans urethrally [TURP, PURP Trans urethral or pre urethral resection of prostate.]
Transurethral resection of prostate has largely replaced other methods unless
diverticulectomy or the removal of large stones necessitates open operation.
Complication of operation: 1 Local and
2 General
Local complication
Haemorrhage is the most tiresome complication following prostatectomy whatever surgical
approach. Secondary haemorrhage tends to occur around the tenth postoperative day and
is usually associated with the patient overexerting himself or the presence of urinary
infection.
Perforation of the bladder or the prostatic capsule can occur.
Infection in the bladder, epididymis or kidney.
Incontinence is inevitable if the external sphincter mechanism is damaged.
Retrograde ejaculation and impotence-- All patients having a prostatectomy should be
warned that they are likely to suffer from retrograde ejaculation.
[This occurs once the bladder neck is rendered incompetent.]
Stricture may occur secondary to prolonged catheterization.
Bladder neck contracture due to the over use of the coagulating diathermy.
General complication: Cardio vascular system- pulmonary atelectasis, pneumonia, myocardial- infarction
congestive cardiac failure and deep vein thrombosis.
Water intoxication- the absorption of water in to the circulation at the time of a transurethral resection can give rise to congestive cardiac failure, hypo- natraemia and
haemolysis.
Homoeopathic medicine
Argentum nitricum - Emission of a few drops after having finished. Divided stream. Profuse
urine and terrible cutting pain. Bloody urine. Urine passes unconsciously day and night.
Impotence. Erection fails when coition is attempted.
Aloes soc- urinary incontinence in aged. Bearing down sensation and enlarged prostate.
Scanty high coloured urine.
Baryta carb- Diseases of the old man when degenerative changes begin who have
hypertrophied prostate or indurated testis. Very sensitive to cold, offensive foot sweats,
very weak and weary must sit or lie down or lean on something.
Chimaphila umbellata- Acts principally on kidneys and genitourinary tract. Prostatic
enlargement- must strain before flow comes. Scanty urine. Acute prostatis, retension and
feeling of a ball in perineum. Unable to urinate without standing with feet wide apart and
body inclined forward. Urine turbid, offensive containing ropy or bloody mucus and
depositing a copious sediment.
Ferrum picricum is considered a great remedy to complete the action of other medicine.
Senile hypertrophy of the prostate. Pain along entire urethra. Frequent micturition at night
with full feeling and pressure in rectum. Smarting at neck of bladder and penis. Retonsion
of urine.
Hydrangea A remedy for gravel, profuse deposit of white amorphous salts in urine.
Burning in urethra and frequent desire. Urine hard to start. Great thirst with abdominal
symptoms and enlarged prostate.
Populus tremuloides- Catarrh of the bladder especially in old people. Good remedy in
vesical troubles after operations. Severe tenesmus. Painful scalding. Prostate enlarged.
Pain behind pubis at end of urination.
Sabal aerrulata Has unquestioned value in prostatic enlargement, epididymitis and
urinary difficulties. Acts on membrano-prostatic portion of urethra. Iritis with prostatic
trouble. Fear of going to sleep. Desire for milk. Constant desire to pass water at night.
Cystitis with prostatic hypertrophy. Discharge of prostatic fluid. Coitus painful at the time
of emission.
Senecio aureus- Has marked action over the urinary organs. Scanty high coloured urine
with much mucus and tenusmus. Great heat and constant urging. Dull heavy pain in
spermatic cord extending to testicles.
Solidago virga Urine scanty, reddish brown, thick sediment, dysurea, gravel. Difficult
and scanty. Clear and offensive urine. Some times make the use of catheter unnecessary
Sulphur- Frequent micturition especially at night. Burning in urethra during micturition
lasts long after. Parts sore over which urine passes. Must hurry, sudden call to urinate.
Great quantities of colourless urine.
Thiosinaminum Enlarged glands.
Thuia- Urinary stream split and small. Frequent micturition accompanying pains. Sensation
of trickling after urinating. Severe cutting after. Desire sudden and urgent but can not be
controlled .Pain and burning felt near neck of bladder with frequent and urgent desire to
urinate.
Thyroidinum Increased flow of urine. Poly urea. Desire for sweets and thirst for cold
water. Worse riding in car.
Beuzoicum acidum-- Highly colured and very offensive urine.
Calcarea flurica-- For hard stony glands.
Calcarea iodata Scrofulous affections, especially enlarged glands.
Conium mac Acts on glandular systemengorging and indurating it. Altering its structure
like scrofulous and cancerous conditions. Much difficulty in voiding urine. It flows and stops
again. Dribbling in old men.
Iodum Frequent and copious dark yellow green.
Lycopodium Urine slow in coming, must strain. Retension. Polyurea during the night.
Pareira bravauseful in renal colic, prostatic affections and catarrh of bladder. Constant
urging, great straining can emit urine only when he goes on his knees pressing head firmly
against the floor. Dribbling after rnicturition. Urethritis with prostatic trouble.
Picricum acidum - Prostatic hypertrophy, especially in cases not too for advanced. Dribbling
micturition. Nightly urging.
Pulsatilla Increased desire worse when lying down. Involuntary urination at night while
coughing. Acute prostatitis. Pain and tenesmus in urinating worse lying on back.
Sarasaprilla Severe pain at conclusion of urination. Urine dribbles while sitting.
Staphysagria- Prostatic troubles. Frequent urination, burning in urethra when not urinating
up on bladder, feels as if it did not empty as if a drop of urine were rolling continuously
along the channel.
Gelsemium
Graphitis
Hepar sulph- Urine voided slowly with out force- drops vertically seems as if some always
remained. Bladder difficulties of old men.
Kali bich- After urinating a drop seems to remain, which cannot be expelled.
Chromium sulphate
Eupatorium purpureum- Albuminuria, diabetes mellitus, strangury, irritable bladder, and
enlarged prostate are a special feud for this remedy. Constant desire - bladder feels dull.
Ikshuganda (Tribulus terrestris)- Useful in urinary affection, especially dysurea, prostatitis
and calculus affection.
Oleum santali (Oil of sandal wood)-- Stream small and slow. Sensation of a ball pressing
against the urethra. Worse standing.
Oxydendrn Prostatic enlargement, vesical calculi. Irritation of neck of bladder.
Piper methysticum (kava kava)-- Urinary and skin symptoms have been verified. Cystitis.
Rhus aromatica Renal and urinary affection. Senile incontinence. Severe pain before or at
beginning of urination. Constant dribbling.
Triticum (Agropyron repens)-- Frequent, difficult and painful urination, incontinence and
constant desire.
Medorrhinumpainful tenesmus when urinating. Urine flows very slowly. Enlarged and
painful prostate with frequent urging and painful urination.
CARCINOMA OF PROSTATE
Carcinoma of the prostate is the common malignant condition in men over the age of 65
years. About 20% of cases of prostatic obstruction prove to be due to carcinoma. It is less
common in Japanese while its incidence is higher and its behavior is more aggressive in
American Negroes.
Carcinoma of prostate, which is an adeno-carcinoma, starts on the outer zone glands of a
normal or hypertrophied prostate and may occur in the false capsule deliberately left behind
after prostatectomy for benign hypertrophy. So prostatectomy for benign hypertrophy of
gland confers little protection from the subsequent development of carcinoma.
Histological appearance
Prostate is a glandular structure consisting of ducts and acini, there for histological pattern
is one of an adeno-carcinoma. A layer of myoepithelial cells surrounds the prostate glands.
The first change associated with carcinoma is the loss of this layer with the glands
appearing in confluence. As the cell type becomes less differentiated more solid sheets of
carcinoma cells are seen.
Local spread
A growth commencing in the posterior zone of the gland is prevented from extending
backwards by the strong tunica of Denovilliers. Consequently it tends to grow up wards to
involve the seminal vesicle. Further upwards extension obstructs the lower end of one or
both ureters the latter terminating in anuria. Carcinoma commencing in a lateral lobe
involves the prostatic urethra early.
In advanced cases the base of the bladder is invaded. The rectum may become stenosed by
growth infiltrating round it. But direct involvement is very late.
Spread by blood stream
Occurs particularly to bones .The Prostate is the most common site of origin for skeletal
metastasis (being followed in turn by the breasts, the kidney, the bronchial tree and the
thyroid gland). The bones most frequently involved are pelvic bones and the lower lumbar
vertebrae. Femoral head, rib cage and skull are other favoured sites. The frequent proximity
of skeletal metastases to the primary growth has been attributed to reversed flow from the
vesical venous plexus to the emissary vein of the pelvic bone during coughing, sneezing etc.
Bony metastases appear in x-ray as sclerotic areas.
Lymphatic spread
Through the lymphatic vessels passing along the sides of the rectum to the lymph nodes
along the internal iliac vein which lies in the hollow of the sacrum.
Through lymphatic which pass over the seminal vesicles and follow the vas deference for a
short distance to drain in to external illiac node.
From both this situation the retroperitoneal lymph node, later the mediastinal lymph node
and occasionally the supraclavicular lymph node become affected.
CLINICAL FEATURES:
Carcinoma prostate usually occurs in older man. Symptoms are very similar to benign
hypertrophy of prostate. (Frequency, urgency and difficulty of micturition.) But the main
difference is that the history is quit short and they get worse rapidly. Incontinence a short
history of up to 6 month and pain on micturition are suggestive features of carcinoma in a
patient with history of prostatism.
According to the progression of disease; it can be classified in to 5 types.
Type 1: Discovered only on histological examination of tissue removed at prostatectomy.
Type 2: Rectal findings of a hard nodule or extension outside the capsule, investigated by
perineal biopsy.
Type 3: The primary may be tiny and occult, the patient presenting with the rheumatism or
arthritis with blood acidphosphatase level often very high. Urinary symptoms are absent or
slight. The prostate specific antigen (PSA) is high.
Type 4: Pain in the back or sciatica is the main symptoms. Bilateral sciatica in an elderly
man is most often due to metastases in the spine from a carcinoma of the prostate.
Oedema of one or either legs, paraplegia or a spontaneous fracture is occasionally due to
metastases from a carcinoma of the prostate. Anaemia may be the presenting symptoms.
On account of destruction of bone marrow, bone metastases from carcinoma of prostate can
give rise to a haernorrhagic diathesis and the patient suffers haernorrhage often severe, not
necessarily from the urinary tract.
If the malignant gland obstructs the urethra, the patient complaints of difficulties in
micturition, urinary retension, infection, stones or renal failure. (Indistinguishable from
those caused by benign hypertrophy of prostate) Because carcinoma begins in outer zone
glands, it only obstruct the urethra when it is locally advanced and some patient have no
urinary symptoms but they have pain in back or sciatica caused by bony metastases.
Rectal examination:
Bimanual examinations under anesthesia, together with cystoscopy and needle biopsy are
essential in order to assess the local stage of growth. Irregular indurations with stony
hardness in part or in the whole of gland with obliteration of the median sulcus suggests
carcinoma .
TNM -Classification (adopted by the international union against cancer)
This is a detailed clinical staging, which is arrived at simply by the clinician ascertaing the
following points during his examination of the patient.
1. What is the extent of the primary turner?
2. Are there any lymph node affected?
3. Are there any metastases?
TUMOUR
NODES
METASTASES
T.O- Clinically unsuspected
N. 0- No evidence of involvement of regional lymph node
M.0- No evidence of distant metastases
T. 1- Local nodule
N. 1- Involvement of one regional lymph node.
M. 1-Distant metastases.
T.2-Difuse or deforming capsule.
N.2- Involvement of several regional node.
T.3-Out side capsule or extension in to vesicle
N.3- Fixed mass of regional lymph node
T.4- Fixed to the other tissue.
N.4- Involvement of common illiac or Para-aortic node
INVESTIGATION
Blood: Hemoglobin percentage (Leucoerythroblastic anaemia secondary to extensive
marrow invasion or anaemia may be secondary to renal failure)
Platelet count: Platelet count sometimes reduced when metastases present.
Renal function test: Because hydronephrosis may exists from chronic bladder out flow
obstruction or from direct invasion of one or both of the ureters by the carcinoma.
Liver function test: Abnormal when there is extensive metastatic invasion of the liver.
Alkaline phosphatase may be raised from hepatic involvement or from secondaries in the
bone.
Acid phosphatase: Prostatic fraction can be measured by an enzyme technique or a radio
immuno assay. A raised value is strongly suggestive of prostatic carcinoma. 20 % of patient
with metastases will have a normal value. So it is not a good screening test.
Prostatic specific antigen: Measurement of prostatic specific antigen is now thought to have
great specificity when looking for a response to treatment.
Radiological: X-ray chest- metastases in the lung fields or the ribs.
Abdominal X-ray - sclerotic metastases too commonly in the lumbar vertebra and pelvic
bones.
Ultrasonography: Transrectal ultrasound helpful in staging local disease.
Bone scan: Achieved by the injection of technetium 99 the isotope is then monitered using a
gamma camera.
Lymphangiography: Assessment of lymph nodes in the pelvis can be performed by
lyraphangiography.
Bone marrow aspiration: Reveal the presence of metastatic carcinoma cells.
Biopsy: Using a Vin Silverman needle transrectally can be done if the diagnosis ii in doubt.
TREATMENT
Surgery:
1. Trans urethral resection (TUR)
TUR is done in the presence of out flow obstruction. This will give material for diagnosis and
provide symptomatic relief. TUR may not remove all the local cancer. It may be appropriate
if the bone scan is normal.
2. Radical prostatectomy
Radical prostatectomy commonly results in total urinary incontinence and loss of potency.
3. Pelvic lymph node dissection and 1-131 seed implantation
A pelvic lymph node desection with frozen section examination is performed. I 131 seeds
are then implanted into the prostate assuming the nodes are free of tumor. This technique
CLINICAL FEATURES
1. Causing chronic posterior urethritis- specimen shows 50 or more pus cells/ HPF.
2. Causing epididymitis
3. Pain- Local pain (dull ache) in the perineum and rectum. Aggravated by sitting on a hard
chair.
Referred pain- Low back ache, lumbago, some times extending down the leg.
4. Silent prostatitis Pus has been obtained from the prostate. No other symptoms. (But
patient may have arthritis, myositis, neuritis and sometimes iritis and conjunctivitis.)
5. Recurring attacks of mild pyrexia.
6. Sexual dysfunction Premature ejaculations, prostatorrhoea and impotence.
DIAGNOSIS
1. A 3-glass urine test- If the first glass shows urine containing prostatic threads, prostatitis
is present.
2. Rectal examination- May or may not confirm the diagnosis.
3.Examination of the prostatic fluid- Obtained by prostatic massage. (Normal prostatic fluid
is slightly opalescent and viscid.) May show many pus cells and sometimes bacteria.
4. Urethroscopy Reveals inflammation of prostatic urethra.
TREATMENT
Acute prostatitis: Avoidance of alcohol and sexual intercourse for six week is wise.
HOMOEOPATH1C MEDICINE
Aconite
Aesculus Discharge of prostatic fluid at stool. Frequent, scanty, dark and hot urine.
Apis mel
Belladonna
Bryonia
Cantharis-- Intolerable urging & tenesrnus, urine scald him &is passed drop by drop.
Constant desire to urinate.
Chimaphilla
Colchicum-- Urine contain clots of putrid decomposed blood, albumin & sugar.
Copaiva Act powerfully on mucus membrane especially that of urinary tract turbid color.
Peculiar pungent odor.
Cubeba-- _ Mucus membrane generally especially that of the urinary tract. Prostatis with
thick yellow discharge.
Digitalis Continued urging in drops dark, hot burnings with sharp cutting pain at the neck
of bladder as if a straw was being thrust back & forth, ammoniacal & turbid urine.
Ferrum Phos
Gelsemium
Hepar sulph
Iodum
Kali iod
Merc cor
Merc dul
Nitric acidScanty dark offensive smells like horse urine. Cold on passing. Alternation of
cloudy phosphatic urine with profuse urinary secretions in old prostatic cases.
Nitrum
Olium santele
Pichi (Fabiana imbricta)--Vesclcal cattarah with suppurative prostatic condition.
Picric acid
Pulsatilla
Sabadilla
Sabal .Ser
Salix nigra_ Has a positive action on the generative organs of both sexes.
Selenium
Silicea
Solidago
Staphysagria
Thuja
Triticum
Verat .v
Vesicaria
CHRONIC PROSTATIS
Aurm me
Baryta carb
Brachyglottis
Caladium
Carbonium sulph
Causticum
Clematis
Conium mac
Ferrum Picricum
Graphitis
Hepar sulph
Hydrocotyl
Iodum
Lycopodium
Merc cor
Merc sol
Nitric acid
Nux vomica
Phytolacca
Pulsatilla
Sabadilla
Sabina
Sepia
Selenium
Silicea
Solidago
Staphysagria
Sulphur
Thuja
Tribulus
PROSTATIC CALCULI
Two types
1.Endogenous: Common are usally composed of calcium phospahte plus 20% of organic
material
2. Exogenous: Rare-- is a urinary (ureteric) calculus that become arrested in prostatic
urethra.
CLINICAL FEATURES
Often symptomless, being discovered on X- ray of pelvis for any other cause. Symptoms are
at first those of chronic prostatis or prostatic obstruction.
Treatment
Small calculi; Symptoms mild - Treatment of c/c prostatitis
Trans urethral resection
Retropubic prostato lithotomy
TUBERCULOSIS OF THE PROSTATE
Tuberculosis of prostate and seminal vesicles associated with renal tuberculosis in at least
60%. In 30% there is history of pulmonary tuberculosis.
Rectal examination reveals one or more well defined nodules most often near the upper or
lower border of one or both lateral lobe.
CLINICAL FEATURES
Urethral discharge is the first symptoms. Painful sometimes bloodstained ejaculation (20
%). Mild ache in the perineum. Infertility (fertility very much reduced). 80% are sterile.
Urinary symptoms When the posterior urethra becomes involved from extension of
tuberculosis from the prostate- there is painful, frequent micturition and sometimes
terminal haematuria.
Abscess formation- Cold abscess formation in the prostate. (Slightly tender soft swelling) It
usually ruptured in to the urethra, rarely through the perineum or in to the rectum. If a
recto prostatic fistula develops it is extremely difficult to heal even when the tuberculous
infection has been eliminated. (If a prostatic abscess forms it is better to evacuate it by the
perineal route than to permit it to rupture spontaneously.)
INVESTIGATION
Radiography large scattered area of calcification
Bacteriological examination of fluid- gives positive culture of tubercle bacilli.
Posterior urethroscopy- reveals one or more dilated prostatic duct plus tubercle bacilli in the
ejaculate- establishes an absolute diagnosis.
TREATMENT
General and treatment for tuberculosis.