MUTRAGHATA IN SHALYATANTRA

MUTRAGHATA

• Mutraghata is a collective term for obstructive uropathies or retention of urine due to various causes.

• It is mainly a Vata-dominant disorder affecting the urinary system.

• Classified under Ashtamahagada (eight grave disorders) due to its severity and complications.

• Can be correlated to modern conditions like Benign Prostatic Hyperplasia (BPH), Urethral Stricture, Neurogenic Bladder, and Urinary Retention.

SANSKRIT DEFINITION AND ETYMOLOGY

• Mutraghata = Mutra (urine) + Aghata (obstruction or suppression).

  अश्मर्यादीनि दोषैश्च प्रमेहादीनुपद्रवैः।
  यच्चोत्क्लेशादिनिर्मुक्तं मूत्रं संरुध्यते मुहुः॥
  तन्मूत्रघात इत्युक्तो गम्भीरश्चोपदिश्यते॥
  — Sushruta Samhita, Nidana Sthana, 3/6

NIDANA (CAUSES)

AYURVEDIC CAUSES

• Vata prakopaka nidana (causative factors that aggravate Vata):

  • Ati vyayama (excessive exertion)

  • Ruksha, Laghu ahara
    

  • Vega dharana (suppression of natural urges)

  • Abhighata (trauma)

  • Aashukari karma (violent activities)

• Upadrava of Prameha, Ashmari, Gulma, and Arsha

• Obstruction by aggravated Kapha and Pitta in the urinary channels

MODERN CAUSES

• Benign Prostatic Hyperplasia (BPH)

• Urethral Stricture

• Urinary Bladder Stones

• Bladder Carcinoma

• Prostate Cancer

• Neurological Conditions (e.g., spinal cord injury, multiple sclerosis)

• Post-surgical adhesions or trauma

• Functional Obstruction (neurogenic bladder, detrusor underactivity)

SAMPRAPTI (PATHOGENESIS)

• Vitiated Vata dosha causes sankocha (constriction) or sanga (obstruction) of the mutravaha srotas.

• Leads to:

  • Incomplete urination

  • Painful micturition

  • Total or partial urinary retention

PURVARUPA (PREMONITORY FEATURES)

• Feeling of heaviness in bladder region

• Pain during urination

• Difficulty in initiating urination

• Reduced urinary stream

RUPA (CLINICAL FEATURES)

• Retention of urine (total or partial)

• Lower abdominal discomfort or pain

• Difficulty in micturition

• Dribbling of urine

• Constipation

• Distended bladder (palpable)

  सकृन्मूत्रं स्तम्भयित्वा गुदं तेनोपताडयन्।
  स्फुटितं नाभिपार्श्वं वा व्रणं मूत्रघतो भवेत्॥
  — Ashtanga Hridaya, Nidana Sthana, 9/23

TYPES OF MUTRAGHATA (AYURVEDIC CLASSIFICATION)
(As described in Sushruta Samhita and Ashtanga Hridaya)

• Vataja Mutraghata – Painful retention due to dryness and obstruction by Vata

• Vatakundalika – Twisting pain due to Vata vitiation in urinary tract

• Vataastheela – Hard, immobile mass-like prostate condition

• Mutrashukra Sangrahani – Simultaneous retention of semen and urine

• Mutrajathara – Ascites-like condition due to Vata obstructing urine

• Mutravirajaniya – Discoloration of urine due to vitiation

• Achakshushka Mutraghata – Retention with vision disturbance due to systemic Vata vitiation

DIAGNOSIS

AYURVEDIC DIAGNOSIS

• Based on:

  • Dosha predominance (mainly Vata)

  • Site of obstruction (Basti region)

  • Clinical features (roga lakshana)

  • Palpation of distended bladder

  • Nadi pariksha (pulse diagnosis)

MODERN DIAGNOSIS

• Physical examination:

  • Bladder palpation

  • Digital rectal examination (for prostate assessment)

• Investigations:

  • Urine analysis

  • Ultrasound abdomen and pelvis

  • Post-void residual volume assessment

  • Uroflowmetry

  • Urethrography (RGU/MCU)

  • PSA test (Prostate-Specific Antigen)

  • Cystoscopy

CHIKITSA (MANAGEMENT)

AYURVEDIC MANAGEMENT

Sthanika Chikitsa:

• Abhyanga (oleation) with Vatahara tailas (e.g., Bala Taila, Narayana Taila)

• Swedana (sudation) to relieve srotorodha

• Basti (medicated enema) – Matrabasti, Anuvasana, and Niruha basti with:

  • Dashamoola Kwatha

  • Ksheerabala Taila

  • Eranda Taila

Shamana Aushadhi:

• Gokshuradi Guggulu

• Chandraprabha Vati

• Varunadi Kwatha

• Punarnavadi Mandura

• Shilajatu and Yavakshara

Shastra Chikitsa (Surgical):

• In case of Ashmari, Prostatic enlargement, or Urethral Stricture:

  • Urethral dilatation

  • Catheterization (Mutrashaya Nala Pravesha)

  • Suprapubic cystostomy (if catheter fails)

  मूत्रे स्तब्धे पुनःपुनस्तस्य नाभ्याः समुद्धरेत्।
  स्नेहेन मूत्रमार्गेण व्रणं सन्धाय तं जयेत्॥
  — Sushruta Samhita, Chikitsa Sthana, 3/22

MODERN MANAGEMENT

• Catheterization (Foley catheter)

• Medical management (in case of BPH):

  • Alpha-blockers (e.g., Tamsulosin)

  • 5-alpha reductase inhibitors (e.g., Finasteride)

• Surgical options:

  • Transurethral Resection of Prostate (TURP)

  • Urethrotomy (for stricture)

  • Cystostomy

• Treatment of underlying neurological or obstructive cause

COMPLICATIONS

• Hydronephrosis

• Recurrent urinary tract infection

• Renal failure

• Bladder atony or rupture

• Urosepsis

PREVENTION

• Avoiding suppression of micturition (Vega dharana)

• Preventing recurrent UTIs

• Regular checkup for prostatic health in elderly males

• Healthy bladder habits

PROGNOSIS

• Prognosis depends on cause and duration.

• Early intervention in Vataja Mutraghata has better outcomes.

• Chronic retention leads to complications and poor prognosis.