Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia...

[Full title: Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia adopted by Ayurveda practitioners - A Survey Study]

[[[ p. 1 ]]]

[[[ p. 2 ]]]

[Find the meaning and references behind the names: Prasanth]

ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 24 Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia adopted by Ayurveda practitioners - A Survey Study Abhijeet Dahiya 1 , Prasanth Dharmarajan 2 1 Post Graduate Scholar, Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India. 2 Assistant Professor, Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India. I NTRODUCTION Benign Prostatic Hyperplasia (BPH) refers to the nonmalignant growth of the prostate gland, mostly found in ageing men. Most common symptoms of BPH typically include urinary urgency, frequent urination, involuntary urination, urge incontinence, urinary hesitancy, intermittency, weak urinary stream, nocturia Address for correspondence: Dr. Abhijeet Dahiya Post Graduate Scholar, Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India. E-mail: dr.abhijeetdahiya@gmail.com Submission Date: 11/01/2022 Accepted Date: 19/02/2023 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.8.3.4 etc [1] Modern treatment methods include oral medications such as 5α - reductase inhibitors, α1 Adrenergic Antagonists (α1 -Blockers), Muscarinic Receptor Antagonists (MRAs) or combined therapies. Common side effects of these oral medications include postural hypotension, ejaculatory dysfunction, erectile dysfunction, gynecomastia, pruritis, constipation, acute urinary retention etc [4] Surgical treatment methods include Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP), Greenlight laser therapy, Prostatic urethral life, Prostate Artery Embolization, Robot-assisted simple prostatectomy etc. These methods also come with their share of side effects [5][6] Thus, there is a need to find treatment methods with minimal or no side effects. In Ayurveda, symptoms of BPH can be related to those of Mutraaghata as mentioned by Acharya Sushruta, A B S T R A C T Introduction: Benign Prostatic Hyperplasia (BPH) refers to the nonmalignant growth of prostate gland. In Ayurveda, it can be correlated with Mutraaghata or Mutradosha. Currently used common oral medications such as 5α -reductase inhibitors, α1 -Blockers as well as surgical treatment methods such as Transurethral Resection of the Prostate (TURP) have well-known side effects. Ayurveda case studies on BPH show evidence of a potential alternative to these current methods Objectives: To conduct a survey to know the diagnostic methods and treatment modalities used by different Ayurveda Practitioners in BPH treatment. Materials & Methods: A survey comprising 7 questions in the form of multiple-choice questions on the diagnosis and treatment methods of BPH adopted by Ayurveda Physicians was done. The answers were recorded and interpreted in the form of graphs and pie charts. Results: A total of 57 different Ayurveda practitioners participated in the survey. Prevalence of BPH was seen more in the age group of 60- 70 years. Ultrasonography (USG) and Prostate Specific Antigen (PSA) were among the most commonly used diagnostic methods for BPH. Most common symptoms observed were increased frequency of urine, urine incontinence and urine urgency. Uttara Basti (administration of medicine through the urethra) was the most recommended type of treatment procedure preferred, followed by Matra Basti (enema) . Avagaha Swedana (Sitz bath) was recommended by most practitioners. The course duration of treatment is advised to be around half to one month. Around 40-60% relief was claimed in patients with BPH by the participants. Conclusion: BPH is a condition that is currently being treated by various Ayurveda practitioners using classical treatment methods such as Uttara Basti, Matra Basti etc. with claimed relief of about 40-60% by the participants. Key words: Avagaha Swedana, Benign Prostatic Hyperplasia, Bladder Outlet Obstruction, Lower Urinary Tract Symptoms, Mutraaghata, Prostatomegaly, Uttara Basti

[[[ p. 3 ]]]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 25 and Mutradosha according to Acharya Charaka. There are 12 types of Mutraaghata described by Acharya Sushruta [2] and 13 types of Mutradosha described by Acharya Charaka. [3] There have been many studies already done to cure patients with BPH using classical treatment methods mentioned in Ayurvedic texts. So, a survey was conducted to assess the approach of various Ayurveda practitioners for the treatment of BPH. M ATERIALS AND M ETHODS An online survey was developed which comprised of 7 questions in the form of MCQs. It was circulated among various Ayurveda practitioners working in private clinics, hospitals, and doctors in the northern part of India via email and social media groups. Data such as participant’s names, qualification, contact details etc. were collected. Survey data was collected, recorded and interpreted in the form of graphs and pie charts. The questionnaire of the survey data sheet included: Table 1: Survey questions and response choices SN Questions Choices 1 What is the most common age group of patients treated by them? a) 40 yrs – 60 yrs b) 60 yrs – 70 yrs c) 70 yrs – 80 yrs d) Above 80 yrs 2 What were the most common complaints / symptoms of patients with BPH? a) Frequent Urination b) Urinary Incontinence c) Pain during or after micturition d) Urinary Urgency e) Burning Sensation during micturition f) Nocturia g) Urinary Retention h) Weak or Interrupted Urine Stream i) Trouble Starting a Urine Stream j) Hematuria 3 What was / were the diagnostic method / methods used you for the diagnosis of BPH? a) Based on Symptoms b) Prostate Specific Antigen (PSA) c) Ultrasonography (USG) d) Prostate MRI e) Cystoscopy f) Renal Function Test g) Urine Examination – Routine and Microscopic h) Digital Rectal Examination i) Based on the International Prostate Symptom Score (IPSS) Uroflowmetry 4 Which Basti would you recommend or use for treating BPH? a) Niruha Basti b) Anuvasana Basti c) Matra Basti d) Uttara Basti e) Oral Medication 5 Will you recommend / include Avagaha Swedana as a Poorvakarma of Basti for BPH? a) Yes b) No 6 What is the usual course of duration for the above-mentioned therapies / procedures? a) 0-7 days b) 8-15 days c) 16-30 days d) >30 days e) Depending upon the condition of the disease f) For 1 week followed by a certain gap period and again use the planned intervention. 7 How much relief was observed in the patients with the above treatment? a) <20% b) 20%-40% c) 40%-60% d) 60-80% e) >80%

[[[ p. 4 ]]]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 26 O BSERVATIONS AND R ESULTS A total of 57 Ayurveda practitioners participated in the online survey. The responses were recorded in the form of graphs and pie charts. As per the responses from 57 participants, the prevalence of BPH was most commonly found in the age group of 40 to 60 years by 28 (49.1%) participants, in 60 to 70 years by 30 (52.6%) and in 70-80 years by 5 (10.5%) participants. (Graph 1) Graph 1: Most common age group of patients with BPH For the diagnostic criteria, diagnosis based on symptoms was answered by 40 participants (70.2%), PSA score by 37 participants (64.9%), Ultrasonography by 38 participants, Prostate MRI by 15 (26.3%) participants, Cystoscopy by 5 participants (8.8%), Renal Function Test by 8 (14%) participants, Routine and Microscopic Urine Examination by 21 participants (36.8%), Digital Rectal Examination by 16 participants (28.1%), diagnosis based on International Prostate Symptom Score by 13 (22.8%) and Uroflowmetry by 1 (1.8%). (Graph 2) Graph 2: Basis of diagnosis of BPH Frequent Urination was one of the most common symptoms observed by 41 participants (71.9%), followed by Urine Incontinence by 35 (61.4%) participants, pain during or after micturition by 23 (40.4%) participants, Urinary Urgency by 33 (57.9%) participants, burning sensation during micturition by 12 (21.1%) participants, Nocturia by 20 (35.1%), Urine retention 27 (47.4%), weak or interrupted urine stream by 27 (47.4%), trouble starting a urine stream by 28 (49.1%) and hematuria by 5 (8.8%) participants. (Graph 3) Graph 3: Most common symptoms observed in patients with BPH When asked about the most preferable type of Basti , 47.4% of participants chose Uttara Basti as the recommended Basti that should be given to patients of BPH. 24.6% of participants recommended Matra Basti is the preferred type, followed by Niruha Basti recommended by 21.1% of participants. (Graph 4) When asked if the participants would include Avagaha Swedana (Sitz Bath) as a part of their treatment, 83% of the participants agreed that they recommended Avagaha Swedana in BPH, while 17% disagreed and did not recommend using it as a part of their treatment. (Graph 5) Graph 4: Preferred type of treatment

[[[ p. 5 ]]]

[Find the meaning and references behind the names: Long]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 27 Graph 5: Avagaha Swedan recommendation When the participants were asked how long they would recommend giving the above-mentioned therapies/treatments to patients with BPH, 29.8% of participants recommended 8-15 days, followed by 28.1% participants for 16-30 days, 21.1% for more than 30 days, 17.5% for 0-7 days. 1 of them (1.7%) is recommended to treat depending on the condition of the disease. A small group of participants (1.7%) chose to give the treatment depending upon the severity of the disease and the rest of them recommended giving treatment for 1 week, followed by a certain gap period, and again using the planned intervention. (Graph 6) 47.4% of the participants claimed 40-60% relief in patients after treating them with Ayurveda therapies and medications, 24.6% claimed 20%-40% relief, followed by 22.8% of participants who claimed 60-80% of relief in patients, remaining 3.5% claimed more than 80% relief in patients, and 1.7% participants claimed less than 20% relief in patients of BPH. (Graph 7) Graph 6: Course of duration of treatment Graph 7: Relief observed in patients DISCUSSION Benign Prostatic Hyperplasia (BPH) is a condition that greatly affects the quality of life of the elderly. The present treatment modalities are known to have many complications. Mutraaghata being a Saadhya (treatable) condition as per Ayurveda, holds resemblance with the symptoms of BPH. Therefore, in many studies, the BPH is treated with the same methods that are mentioned for Mutraaghata in the ancient Ayurvedic texts. According to this survey, the prevalence of BPH was mostly seen in the patients lying in the 60-70 yrs age group. As per a study, the size of the Prostate Gland increases with age in males. It was demonstrated that across a wide spectrum of racial and ethnic groups, prostate size increases from 25 g to 30 g for men in their 40 s to 30 g to 40 g for men in their 50 s and 35 g to 45 g for men in their 60 s. Also, the histologic prevalence of BPH, according to a study, is found to be approximately 10% for men in their 30 s, 20% for men in their 40 s, reaches 50% to 60% for men in their 60 s, and is 80% to 90% for men in their 70 s and 80 s [7] Hence, it establishes the fact that BPH and its symptoms are more prevalent in age >60 yrs. The diagnosis is made mostly using Ultrasonography (USG) of the prostate region, levels of Prostate Specific Antigen (PSA) and based on symptoms. Symptoms are diagnosed and scored mostly using the International Prostate Symptom Score (IPSS) scale developed by American Urological Association (AUA). Other diagnostic methods that are also used are digital rectal examination, prostate MRI, cystoscopy, uroflowmetry, urine culture test, etc. According to one study, the accuracy of transabdominal ultrasonography for benign lesions was 91.66% [13] USG remains the most common tool used for the diagnosis of BPH, as it can help examine both size and volume of the prostate gland. Post Void Residual Urine Volume can also be calculated with the help of USG. Early studies suggested that PSA density could help differentiate between BPH and early nonpalpable cancer, especially at serum levels of 4.0 to 10.0 ng/mL [14] Mostly, preliminary diagnoses can be

[[[ p. 6 ]]]

[Find the meaning and references behind the names: Low]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 28 made using symptoms that are mostly specific to BPH in elderly patients. Hence, it becomes an important aspect in the diagnosis of any condition, here particularly in BPH. Frequent urination, urine incontinence and urgency were among the most observed symptoms by the participants. BPH may lead to Bladder Outlet Obstruction (BOO) with high bladder pressures and low flow, which in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction [15] Mutraaghata is believed to be a disorder mainly caused by the vitiation of Vata Dosha. [8] Basti (enema) treatment has been defined as the best treatment for Vata. In the context of urinary disorders, Uttara Basti has been specifically described along with other procedures [9] Unlike an enema, Uttara Basti is a method where medicine is injected through the urethra in males, and in the urethra or vaginal canal in females. Ashrani and Sumedh report that Uttara Basti with Ushiradi Taila given on a repeat interval of 3 days had significant results in the symptoms of BPH [16] Matra Basti is also a type of Basti, where medicated oil is pushed through the anal canal. Matra Basti with Dhanyak Gokshura Ghruta given for 15 days in a month for 2 months along with Karkati Beeja powder 5 g two times a day for 2 months showed, symptomatic relief and there was a significant decrease in prostate weight and post residual urine volume [17] In many previous studies, Uttara Basti and Matra Basti, both have been shown to be very effective in treating BPH [10][11] There have been various opinions regarding the choice of Basti in BPH, but Uttara Basti is a type which is described by all the Acharyas for Mutraaghata. For the treatment of complications caused by holding the natural urges like micturition, defecation etc., Avagaha Swedana (sitz bath) has been mentioned in Ayurveda texts, which is a type of sudation in which the patient is made to sit in a tub filled with hot water or medicated decoction. Apaturkar et al. in their study administered Laghu Panchamoola Kwatha 30 ml two times before meals and for Avagaha Swedana 3 times a day for a total duration of 45 days in BPH. They found 50% relief in incomplete voiding, frequency, intermittency, straining, weak stream & Nocturia followed by 66.6% relief in urgency [18] Kanchanara Guggulu has also been shown effective in various studies [11][12] In Mutraaghata, the obstruction is known to be caused by Kapha Dosha along with Vata, and Kanchanara Guggulu, having the effect of Vata- Kapha Dosha, and also is used in the treatment of cysts or any abnormal growth, is also effective in treating BPH. Kanchanara Guggulu contains kaempferol and quercetin flavonoids which prevent estrogen receptor conditions such as urinary incontinence and urogenital atrophy [19] Kanchanara Guggulu has Triphala and Trikatu as constituents which have ascorbic acid (Vitamin C) which helps to relax the smooth muscle of the prostate and bladder neck to relieve pressure and improve urine flow [20] As for the duration of treatment, Uttara Basti and Matra Basti are usually administered for a minimum period of 7-8 days or more, as per the severity of the condition. In this survey, the duration of treatment was advised mostly for half to one month which can include both, therapies (enema etc.) and oral medications. As per the survey, most of the practitioners claimed 40- 60% relief in the overall condition of patients. This can be mostly based on the improvement in the chief complaints and symptoms of patients. The amount of relief can also depend on other factors, such as the chronicity and severity of the condition, age of the patient, the choice of medications etc. Recommendations Though the sample size of the survey was small, and the questionnaire only consisted of 7 questions, a large study can be done with a larger group to further know the variety of treatments adopted by Ayurveda practitioners pan India or worldwide, including the Ayurveda formulations used in procedures and oral

[[[ p. 7 ]]]

[Find the meaning and references behind the names: Bala, Benson, Singh, Yadav, Gupta, Walsh, Campbell, Ayu, Mar, Chao, Huang, Jun, Patel, Jordan, Med, Cheng]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 29 medications. Cross-sectional studies can also be done to get a wider perspective of the condition. CONCLUSION In this survey, we came to know about the most used diagnostic methods, treatment methods, age group, symptoms and relief observed in patients with BPH as per the experience of different Ayurveda practitioners. The prevalence of BPH was most commonly seen in the age group of 60 to 70 years, followed by 50 to 60 years. It is clear that Ayurveda treatment modalities can help relieve the symptoms of BPH by up to 40-60% in most cases. Out of many diagnostic methods available, USG and PSA along with the assessment of symptoms prove to be a reliable basis of an investigation in most of the cases. Uttara Basti and Matra Basti remain the choice of treatment modalities among Ayurveda practitioners These can be a better alternative to currently widely used treatment options such as alphablockers etc. which come with a fair share of side effects REFERENCES 1 Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7 Suppl 9(Suppl 9):S 3-S 14. 2 Sushruta, Sushruta Samhita, Acharya Yadavji Trikamji (editor), Nibandha Sangraha Commentary by Dalhana, Nidana Sthana, Ashmarinidanam, 3/21-23, Varanasi: Chaukhamba Surabharati Prakashana; 2008, p 280. 3 Agnivesha, Charaka Samhita, Vidyotini Hindi commentary by Shastri K, Chaturvedi G. Part II, Siddhi Sthana, Trimarmiyarsiddhi, 9/25-26, Varanasi: Chaukhambha Bharti Academy; 2016, p.1057. 4 Yu ZJ, Yan HL, Xu FH, Chao HC, Deng LH, Xu XD, Huang JB, Zeng T. Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Front Pharmacol. 2020 May 8;11:658. doi: 10.3389/fphar.2020.00658. 5 Lokeshwar SD, Harper BT, Webb E, Jordan A, Dykes TA, Neal DE Jr, Terris MK, Klaassen Z. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019 Oct;8(5):529-539. doi: 10.21037/tau.2019.10.01. 6 Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006 Nov;50(5):969- 79; discussion 980. doi: 10.1016/j.eururo.2005.12.042. 7 Roehrborn C, McConnell J. Etiology, pathophysiology, epidemiology and natural history of benign prostatic hyperplasia. In: Walsh P, Retik A, Vaughan E, Wein A, editors. Campbell’s Urology. 8 th ed. Philadelphia: Sa unders; 2002. pp. 1297 – 1336. 8 Sushruta, Sushruta Samhita, Acharya Yadavji Trikamji (editor), Nibandha Sangraha Commentary by Dalhana, Nidana Sthana, Ashmarinidanam, 3/27-28, Varanasi: Chaukhamba Surabharati Prakashana; 2008, p 280. 9 Agnivesha, Charaka Samhita, Vidyotini Hindi commentary by Shastri K, Chaturvedi G. Part II, Siddhi Sthana, Trimarmiyarsiddhi, 9/49-50, Varanasi: Chaukhambha Bharti Academy; 2016, p.1063. 10 G B, VD M, SK G, TS D. Efficacy of Ayurveda Formulations and Basti Chikitsa on Mutraghata w.s.r. to Benign Prostatic Hyperplasia: a review on researches conducted at Gujarat Ayurved University, Jamnagar. Int J Ayu Pharm Res. 2015 Dec.15 11 Patel JK, Dudhamal TS, Gupta SK, Mahanta V. Efficacy of Kanchanara Guggulu and Matra Basti of Dhanyaka Gokshura Ghrita in Mootraghata (benign prostatic hyperplasia). Ayu. 2015 Apr-Jun;36(2):138-44. doi: 10.4103/0974-8520.175552. 12 Banothe GD, Mahanta V, Gupta SK, Dudhamal TS. A clinical evaluation of Kanchanara Guggulu and Bala Taila Matra Basti in the management of Mutraghata with special reference to benign prostatic hyperplasia. Ayu. 2018 Apr-Jun;39(2):65-71. doi: 10.4103/ayu.AYU_117_15 13 Singh N, Shenoi UD, Raghuveer CV. FNAC and transabdominal ultrasonography in the diagnosis of prostatomegaly. Indian J Pathol Microbiol. 1997 Oct;40(4):473-9. 14 Benson MC, Whang IS, Olsson CA, McMahon DJ, Cooner WH. The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol. 1992 Mar;147(3 Pt 2):817-21. doi: 10.1016/s 0022-5347(17)37394-9. 15 Speakman MJ, Cheng X. Management of the complications of BPH/BOO. Indian J Urol. 2014 Apr;30(2):208-13. doi: 10.4103/0970-1591.127856. 16 Ashrani B, Sumedh W, Case study of ushiradya tail uttarbasti on vatasthila W.S.R to benign prostatic hyperplasia. Int J Res Ayurved Med Sci 2020;3:154-6. 17 Jaiswal AS, Yadav SR. Karkatibeejadi powder and Dhanyaka ‑ Gokshura Ghrita Matra Basti in the management of benign prostatic hyperplasia-case study. Int Ayurved Med J 2015;9:2942-7. 18 Apaturkar NC, Khobragade SS, Karare P, Sawsakade P. Effect of laghupanchmooladi decoction hot sitz bath in the management of Mootraghata WSR to BPH: A case report. World J Pharm Res 2019;9:608-15. 19 Kalogeromitros D, Makris M, Chliva C, Aggelides X, Kempuraj D, Theoharides TC. A quercetin containing supplement

[[[ p. 8 ]]]

[Find the meaning and references behind the names: Nil]

Abhijeet Dahiya et al. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia ISSN: 2456-3110 ORIGINAL ARTICLE March 2023 Journal of Ayurveda and Integrated Medical Sciences | March 2023 | Vol. 8 | Issue 3 30 reduces niacin-induced flush in humans. Int J Immunopathol Pharmacol 2008;21:509-14. 20 Rohrmann S, Giovannucci E, Willett WC, Platz EA. Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Am J Clin Nutr 2007;85:523- 9. ******************************* How to cite this article: Abhijeet Dahiya, Prasanth Dharmarajan. Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia adopted by Ayurveda practitioners - A Survey Study. J Ayurveda Integr Med Sci 2023;03:24-30. http://dx.doi.org/10.21760/jaims.8.3.4 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2023 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia...’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Matra-basti, Mutraghata, Mutradosha, Vatadosha, Survey, Treatment, Surgical treatment, Treatment modalities, To know, Patient, Age-group, Survey study, Treatment duration, Urinary tract, Acharya Sushruta, Acharya Charaka, Ayurveda therapies, Ayurveda practitioners, Ayurveda Text, Benign prostatic hyperplasia, Prostate size, Kanchanara guggulu, Basti Chikitsa, Oral medication, Urinary retention, Urinary tract infection, Lower Urinary Tract Symptoms, International prostate symptom score, Ayurveda physician, Uttara Basti, Frequent urination, Treatment method, Digital rectal examination, Urinary urgency, Prostate gland, Urinary Incontinence, Diagnostic method, Hot sitz bath, Prostatic hyperplasia, Symptoms observed, Ayurveda Formulation, Transurethral Resection, Prostate specific antigen, Side effect, In-Patients, Survey questions, Most common, Surgical method, FNAC, Creative Commons Attribution, In the, By the, And the, Of the, Participant, Prostate, With the, Treatment of, In patients with, Symptom, Used for, Multiple choice question, In the treatment, Urine incontinence, Urine urgency, Of patients, Diagnosis of, Prostatomegaly.