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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 101-106

Benign prostatic hyperplasia: An evidence-based case report treated with homoeopathy


1 Regional Research Institute of Homoeopathy, Agartala, India
2 Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata, West Bengal, India

Date of Submission30-Apr-2015
Date of Acceptance02-Jan-2017
Date of Web Publication2-Jul-2018

Correspondence Address:
Dr. Abhijit Chakma
Clinical Research Unit for Homoeopathy (Under CCRH, Ministry of AYUSH, Government of India), 1/4, Krishnanagar Main Road, Near Colonel Chowmuhani, Agartala - 799 001, Tripura
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7168.235795

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  Abstract 

Benign prostatic hyperplasia (BPH) is commonly seen in men above the age of 50 years and its incidence approaches 75-80% in men above 80 years. It is one of the frequent reasons for elderly men undergoing surgery. BPH symptoms range from least voiding difficulties to urinary retention and renal failure. In this case, treated with Causticum, both subjective symptoms and prostate size were assessed post treatment. This case shows the usefulness of this medicine on subjective and pathological parameters.

Keywords: Benign prostatic hyperplasia, Causticum, Homoeopathy, Individualization, Repertorization


How to cite this article:
Chakma A, Shil RC, Ghosh MS. Benign prostatic hyperplasia: An evidence-based case report treated with homoeopathy. Indian J Res Homoeopathy 2018;12:101-6

How to cite this URL:
Chakma A, Shil RC, Ghosh MS. Benign prostatic hyperplasia: An evidence-based case report treated with homoeopathy. Indian J Res Homoeopathy [serial online] 2018 [cited 2019 Nov 18];12:101-6. Available from: http://www.ijrh.org/text.asp?2018/12/2/101/235795


  Introduction Top


The prostate is an accessory gland of the male reproductive system.[1] Benign prostatic hyperplasia (BPH) is a nonneoplastic tumor-like enlargement of the prostate. It is commonly seen in men above the age of 50 years and its incidence approaches 75–80% in men above 80 years. It is rarely a life-threatening condition but has a significant effect on individual's quality of life in varying degrees.[2] However, symptomatic BPH producing urinary tract obstruction and requiring surgical treatment occurs in 5–10% of cases only.[3]

Some experts believe that a family history of the condition increases a man's risk of developing BPH. Obesity and diabetes are the factors that potentially increase the risk of developing BPH and Lower Urinary Tract Symptoms (LUTS), whereas increased physical activity decreases the risk of BPH.[4] A recent study claims that increased air pollutants have a potential effect on BPH.[5] Obstructive symptoms include hesitancy, poor flow, intermittent stream, dribbling, sensation of poor bladder emptying, episodes of near retention of urine etc. Irritative symptoms such as frequency, nocturia, urgency, urge incontinence, and nocturnal incontinence may occur. Low flow rate and high voiding pressure are the consequence of bladder outflow obstruction.[6]

Among treatment option for BPH-watchful watching approach is adopted when symptoms are mild and not affect the daily activities. Pharmacological intervention undertaken when there is increased resistance to the flow of urine through bladder neck and compressed prostatic urethra. Surgical intervention is considered in case of severe symptoms and in complications such as urinary retention, renal failure and infection.[7]

Homoeopathy has also a good treatment option for patients suffering from BPH. Research study by Reddy et al. showed the efficacy of homoeopathic medicines such as Pulsatilla nigricans, Thuja occidentalis in the treatment of BPH in elderly men.[8] Clinical study by Gupta et al. on BPH shows the efficacy of homoeopathic drugs such as Lycopodium, Pulsatilla, Sulphur, and Calcarea carb.[9] Other scientific works on BPH, a significant contribution made by Oberai et al.,[10] Dole et al.,[11] Hati et al.,[12] and Weinstein.[13] All these scientific works proved the efficacy of homoeopathic medicines in the treatment of BPH. The health system segment of University of Michigan, also says that Chimaphila, Pulsatilla, Apis, Causticum, Clematis, Sabal, Staph, and Thuja are good for treatment of BPH.[14] Recently, Central Council for Research in Homoeopathy has undertaken a work on BPH titled “An open randomized multicentric placebo controlled clinical trial on Homoeopathic therapy for lower urinary tract symptoms in men with BPH.”[15]


  Case Report Top


A male, aged 53 years of average height and moderate built attended outpatient department with complaint of unsatisfactory micturition, feeble urine flow for last 1½ years with sensation of heaviness and fullness of lower abdomen (hypogastric region) and perineum, frequent urination in the evening hours and amelioration (>) from passing urine. He also used to get recurrent attacks of cold, especially in the winter for last 2–3 years. No other major complaints were reported by the patient.

It was a known case of prostatomegaly as the patient was already under treatment of an allopathic doctor with USG report showing the size of prostate 43.4 cc with residual urinary volume 130 cc and left renal cyst. Other investigations such as Prostate Specific Antigen (PSA) level and urine (R/E) were normal. After 1 month of treatment as there was no symptomatic improvement, patient was advised for surgery. Significant morbidity and fear of surgical intervention, patient did not undergo surgery and came to us for homoeopathic treatment.

Patient was stable, well-dressed, very mild, and gentle in talking, does not like to be alone. He likes to do things in perfect orderly manner, sympathetic toward suffering of others, and loves to travel. His appetite is good and has desire for salt and spicy food with moderate thirst and clean, moist tongue. Urine is mild offensive, unsatisfactory, unfinished sensation, passes 9–12 times a day of moderate quantity with more urgency felt in the evening. Bowel movement is regular with scanty, nonoffensive sweat over face and palms. Sleep is sound, refreshing with frequent dream of daily activities. Patient is extremely chilly, prefers rainy, wet weather, and aggravation in winter.

Patient suffered from typhoid in the year 1994, with allopathic treatment he recovered well. No history of major illnesses among family members. Patient by occupation a teacher, of middle-income group has habit of drinking tea (1–2 cups/day). On systemic and local examination, nothing specific abnormality observed. The patient treatment and follow-up of the case mentioned in [Table 1].
Table 1: Miasmatic analysis

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While analyzing the case, general and particular symptoms were classified into common, uncommon, and evaluated as per their merit. Characteristic mentals, physical generals, particulars, and diagnostic symptoms were considered for erecting the totality. Since the case has many generals, so Synthesis Repertory (Version 9.1)[16] is selected for repertorization purpose. Miasmatic analysis was done with the help of repertory of miasm [Table 2] which shows dominance of psoric miasm.[17] After repertorization with the help of RADAR (Rapid Aid to Drug Aimed Research, Archibel Homoeopathic Software. Belgium). 10 by Archibel Homoeopathic software,[18]Sepia, Spongia, Sulphur, Causticum, Silicea, Medorrhinum, Phosphorus, Natrum mur are the leading drugs in this case [Figure 1]. The fastidiousness, sympathetic nature toward others suffering, rainy weather amelioration, attack of cold in the winter season, and salt desire were so prominent in this patient that after consulting materia medica [19],[20],[21] and considering miasmatic background and other symptoms, Causticum, a deep acting, antipsoric medicine was selected for this case. On further study of mental symptoms of Causticum from authentic source books, it is found that Causticum patients are timid, nervous, and afraid of darkness, does not like to be alone.[22] There is fear that something is going to happen with profound anxiety.[23] Since the heaviness felt in the perineum is as usually an indication of prostate enlargement, so the rubric “Prostate gland-Heaviness” also considered from Kent's Repertory,[24] where a handful number of drugs are mentioned including Causticum. Therefore, it was justified to prescribe Causticum 30C, twice daily for 3 days followed by placebo for 10 days in its first visit on August 04, 2014. The follow up details of the patient are given in [Table 2].
Table 2: Follow-up schedule

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Figure 1: Repertorization table

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  Discussion and Conclusion Top


Medical management should be used judiciously in all patients with BPH, with proper individualization. Clinical presentation, proper history, and laboratory investigations help to identify whether one needs urgent surgical or medical treatment or not. A homoeopathically recorded case including detailed history of present illness, family history, history of previous similar illness, and previous interventions is warranted. In this case, all subjective symptoms were improved after taking the medicine. There is also reduction in size of prostate gland from 43.4 cc to 24.76 cc and that of residual urinary volume from 130 cc to 65 cc within a time period of 5–6 months. Other major positive outcome of this case study is that the patient did not have any attack of cold in last winter or any other problem except acute attack of congestive headache. The renal cyst (although tiny) is also disappeared during treatment [Figure 2], [Figure 3], [Figure 4]. The last prescribed Causticum 1M potency helped the patient to overcome the remnant of urinary troubles and since then patient was doing well for almost 4 months and last reported on April 28, 2015, without any significant trouble, further assessment could not be done.
Figure 2: Ultrasonography of whole abdomen before treatment

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Figure 3: Ultrasonography of whole abdomen during treatment

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Figure 4: Ultrasonography of lower abdomen after treatment

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As described earlier, different scientific works published in reputed Indian, International journals have found that homoeopathic medicines are effective in BPH; this case too improved with Causticum once again shows the efficacy of homoeopathic medicines in BPH. This case also shows the significance of individualization in homoeopathy. Homoeopathy considers “man as a whole” and thus this patient too improved subjectively and as well as there was marked decrease in prostate size. Homoeopathic therapeutics may be useful in cases where absolute surgical intervention is not warranted. Thus, the aim of homoeopathic treatment is not only to treat BPH or other troubles but also to address its underlying cause, miasmatic background, individual susceptibility, etc. Although study of a single case does not constitute a strong opinion, but the outcome is encouraging.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

Authors are grateful to Dr. R. K. Manchanda, Director General, CCRH, New Delhi for his constant support and encouragement to carry out evidence-based research studies and dissemination of outcome of such works. Authors are also thankful to Dr. Anil Khurana, Deputy Director General, CCRH, New Delhi for his motivation and guidance in preparing articles in scientific way with proper evidence.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.

 
  References Top

1.
Chaurasia BD. Lower Limb and Abdomen. Human Anatomy. 3rd ed., Vol. II. New Delhi: CBS Publishers & Distributors; 2000. p. 327-30.  Back to cited text no. 1
    
2.
Kumar P, Clark M. Diseases of the prostate gland. Kumar & Clark's Clinical Medicine. 17th ed. New York: Saunders Elsevier Ltd.; 2009. p. 645.  Back to cited text no. 2
    
3.
Mohan H. The male reproductive system and prostate. Textbook of Pathology. 5th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2008. p. 743.  Back to cited text no. 3
    
4.
Reddy GR, Oberai P, Singh V, Nayak C. Treating benign prostatic hyperplasia in elderly men with Homoeopathy – A series of eleven cases. Indian J Res Homoeopathy 2009;3:37-43.  Back to cited text no. 4
    
5.
Shim SR, Kim JH, Song YS, Lee WJ. Association between air pollution and benign prostatic hyperplasia: An ecological study. Arch Environ Occup Health 2016;71:289-92.  Back to cited text no. 5
    
6.
Mann CV, Russell RC, Williams NS. The prostate and seminal vesicles. Bailey & Love's Short Practice of Surgery. 22nd ed. London: ELBS Publication; 1995. p. 971-3, 975.  Back to cited text no. 6
    
7.
Dhingra N, Bhagwat D. Benign prostatic hyperplasia: An overview of existing treatment. Indian J Pharmacol 2011;43:6-12.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Reddy RC, Oberai P, Singh V, Nayak C. Treating benign prostatic hyperplasia in elderly men with Homoeopathy – A series of eleven cases. Indian J Res Homoeopathy 2009;4:37-41.  Back to cited text no. 8
    
9.
Gupta G, Singh JP, Tandon S, Singh S, Nayak C, Singh H, et al. Evidence based clinical study of homoeopathic medicines in patients with benign prostatic hyperplasia. American Jr Homoeopathic Med 2012;105:63-9.  Back to cited text no. 9
    
10.
Oberai P, Roja V, Ramesh D, Arya DD, Reddy GR, Sharma SK, et al. Homoeopathic medicines in the management of benign prostatic hyperplasia: A multicentric prospective observational study. Indian J Res Homoeopathy 2012;6:16-25.  Back to cited text no. 10
  [Full text]  
11.
Dole S, Kandhare AD, Ghosh P, Gosavi TP, Bodhankar SL. The health outcome after homoeopathic treatment in cases of BPH and LUTS: A prospective clinical study. J Pharm Biomed Sci 2012;22:1-7.  Back to cited text no. 11
    
12.
Hati AK, Paital B, Naik KN, Mishra AK, Chainy GB, Nanda LK. Constitutional, organopathic and combined homoeopathic treatment of benign prostatic hypertrophy: A clinical trial. Homeopathy 2012;101:217-23.  Back to cited text no. 12
    
13.
Weinstein C. Benign prostatic hypertrophy: Analysis and homoeopathic treatment. J Am Inst Homoeopathy 2008;101:149-55.  Back to cited text no. 13
    
14.
Available from: http://www.uofnhealth.org/health-library/hn-2251002. [Last accessed on 2015 Dec 05].  Back to cited text no. 14
    
15.
Central Council for Research in Homoeopathy. Homoeopathic therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia: An open randomized multicentric placebo controlled clinical trial. Indian J Res Homoeopathy 2014;8:75-80. Available from: http://www.ijrh.org/text.asp?2014/8/2/75/135639. [Last cited on 2015 Dec 05].  Back to cited text no. 15
    
16.
Schroyens F. Synthesis – Repertorium Homoeopathicum Syntheticum. 9.1 Ver. New Delhi: B Jain Publishers (P) Ltd.; 2009. p. 40, 112, 177, 231, 240, 1024, 1034, 1038, 1052, 1756, 1837, 1905, 1956-7, 2038, 2081.  Back to cited text no. 16
    
17.
Patel RP. Repertory of Miasms. Indian ed. Kottayam: Hahnemann Homoeopathic Pharmacy; 1996. p. 11,42,62,82,440,581,592,596,604,1154,1202,1230.  Back to cited text no. 17
    
18.
RADAR computer programme, version 10 developed by Archibel Homoeopathic Software Company, Belgium. This programme is used for case repertorization purpose as well as to refer study materials, books. 2009.  Back to cited text no. 18
    
19.
Hering C. The Guiding Symptoms of Our Materia Medica. Reprint ed. Vol. VIII. New Delhi: B. Jain Publishers (P) Ltd.; 2005. p. 326-408.  Back to cited text no. 19
    
20.
Boericke W. New Manual of Homoeopathic Materia Medica and Repertory. 9th ed. New Delhi: B. Jain Publishers (P) Ltd.; 2000. p. 110-4, 493-7.  Back to cited text no. 20
    
21.
Allen HC. Keynotes and Characteristics with Comparison of Some of the Leading Remedies of the Material Medica and Nosodes. 6th ed. Calcutta: Modern Homoeopathic Publication; 2000. p. 52-4.  Back to cited text no. 21
    
22.
Farrington EA. Clinical Materia Medica.4t h ed., Ch. LXXII. Revised and enlarged by Harvey Farrington. New Delhi: B Jain Publishers (P) Ltd.; 2011. p. 729.  Back to cited text no. 22
    
23.
Kent JT. Lectures on Materia Medica. Reprint ed. New Delhi: B Jain Publishers (P) Ltd.; 1990. p. 400.  Back to cited text no. 23
    
24.
Kent JT. Repertory of the homoeopathic materia medica. Enriched Indian ed. New Delhi: B Jain Publishers Pvt Ltd; 2006. p. 667.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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