for the use only of a registered medical practitioner or a hospital or a laboratory.

BANGSHIL - AN ADJUVANT TO SURGICAL CONDITIONS

OF GENITO-URINARY TRACT*

By

Dr. B. Mohanty M.S., F.LC.S., Ph.D. Registrar, Surgery, Genito-Urinary Surgery Unit, S.C.B. Medical College, Cuttack.

 

The Indian Practitioner page 139-143 Vol. XXIV No. 2, February 1971

 

 

INTRODUCTION:­

Infections of urinary tract are of frequent occurrence. Often the virulence and mag­nitude of this condition precludes the institu­tion of an otherwise indicated surgical proce­dure. Enormous studies by Herrold, Carrol, Clark and Walthers in this field, help us greatly in understanding the pathological and bac­teriological aspects of it. Such infection and its site, type and associated conditions must be determined before any treatment is,begun. The presence of obstructive lesions like stones, tumours and hypertrophies should be recognised and treated along with urinary an­tiseptics, if maximum cure rate is to be achieved. But, on the other hand, inadequate management of the primary cause results in chronicity, as emphasized by Miller and Boh­nhoft (1966) and Braude et al. (1955). Thus early surgical procedures in obstructive le­sions and appropriate treatment in non­ obstructive infections of the urinary tract, may minimise the serious consequences of endangering life of suffering individual.

 

MATERIAL ANQ METHODS :­

A total of 50 patients, 36 males and 14 females, attending the Urology Department of S.C.B. Medical College, Cuttack, were in­cluded in this study.

Historicai analysis of all the patients in rela­tion to previous illness and instrumentation of urethra, was noted. Meticulous clinical exami­nation and ancillary investigations, like urine examination, culture, plain x-ray of abdomen and pelvis, were done in all cases. I.V.P. was done in two cases and cystoscopy in 35 cases.

Primary treatment pertaining to- the aetiological factor was instituted in each case and all of them were treated with `Bangshil' (a herbo-mineral combination with anti-inflam­matory, antibacterial and antiseptic action on g.u. tract) to correct the associated urinary tract infection, like cystitis and urethritis. Lastly, the therapeutic value of this drug in these patients was assessed.

 

ANALYSIS OF RESULTS:

35 cases of cystitis and 15 cases of non specific urethritis were studied. From these 35 cases of cystitis; 24 were associated with obstructive aetio-pathology of urinary tract and 11 cases came with historical, clinical and investigative evidence of filariasis. Analysis of their complaints, duration, clinical presenta­tion and investigation revealed the diagnosis in each case.

 

TABLE-1 No. of cases

Age in years	Males	Females
0-10	-	-
11-20	2	1
21-30	12	3
31-40	5	4
41--50	5	2
51-60	6	2
60-70	4	1
71-80	2	1
	36	14

Out of total 50 cases, 36 were males and 14 were females. Majority 15 of them belong to the age group 21-30 years.

 

TABLE-II Previous history
Type	No. of cases	%
Catheterisation	16	32%
V.D. exposure	9	18%
Filariasis	11	22%
Rheumatism	15	30%

 

22% of cases came with history of filariasis, 32% with catheterisation, 30% with rheumatism & 18% with V.D. exposure.

 

TABLE-III – Presenting complaints
Type	No. of cases	%
Frequency of urination	50	100%
Dysuria	45	90%
Retention of urine	15	30%
Dribbling of urine	6	12%
Haematuria	10	20%
Urethral discharge	14	28%
Fever	20	40%
Hypogastric pain	35	70%
Joint pain	15	30%

 

 

Majority (100%) of cases came with fre­quency of urination and 90% with dysuria, 70% with hypogastric pain, 40% with fever, 30% with joint pain„ 30% with retention of urine, 28% with urethral discharge, 20%, with haematuria and 12% with dribbling of urine.

 

TABLE-IV            Duration of Symptoms

 

Duration in months	No. of cases	%
One	3	6%
Two	15	30%
Three	12	24%
Four	3	6%
Five	4	8%
Six	4	8%
Over 12 months	9	18%

 

Frequency of urination in association with other symptoms is seen in all cases. The maximum number of cases are seen coming in 2 months and the next number in 3 months' time. 18% of cases are seen coming after 1 year.

 

TABLE-V Clinical features
Signs	No. of cases	%
Suprapubic tenderness	35	70%
Urethral tenderness	15	30%
Epididymitis & funiculitis	11	22%
Beaded urethra	9	18%
Enlarged prostate	5	10%
Tender prostate	3	6%
Nodular prostate	5	10%

 

Clinical examination revealed 70% as cys­titis and 30% as urethritis.

 

 

TABLE-VI Investigations
Type	Reports	No. of cases	% cases
Urine	-	50	100%
Night blood	Microfilaria	9	18%
Plain x-ray	Calculus	2	4%
I.V.P	Delayed emptying and calyceal dilatation	2	4%
Cystoscopy	Trigonal congestion	35	70%

 

 

Urine examination was done in all cases (table VIII). Night blood revealed microfilaria in 18% of cases, 4% showed calculus in plain x­ray. 4% showed delayed emptying and calyceal dilatation. in I.V.P. and 70% showed trigonal congestion in cystoscopy.

 

TABLE-VII Diagnosis
Type	No. of cases	%
Senile hypertrophy of prostate with cystitis	5	10%
Fibrotic prostate with cystitis	5	10%
Prostatitis	3	6%
Calculus cystitis	2	4%
Filarial cystitis	11	22%
Non-specific urethritis	15	30%
Stricture urethra with cystitis	9	18%

 

30% of cases were diagnosed as non­specific urthritis, 22% as filarial cystitis, 18% as stricture urethra with cystitis, 10% as senile hypertrophy of prostate, 10% as fibrotic prostate, 6% as prostatitis, and 4% as cal­culus cystitis.

 

TABLE-VIII - Urine examination

Type	No. of cases	%
Albumin	8	16%
Phosphates	17	34%
R.B.C.	15	30%
Pus cells	46	92%
Epi. cells	42	84%

 

Urine examination showed albumin in 16% of cases, phosphates in 34%, R.B.C. in 30%, pus cells in 92% and Epi. cells in 84% of cases.

 

 

TABLE IX

Showing urine culture and sensitivity to different drugs

Bacilli grown	Drug sensitivity	No of cases	%
E. Coli	Furadantoin	6	12%
E. Coli	Sulpha	8	16%
E. Coli	Chloramphenicol	7	14%
E. Coli	Streptomycin	6	12%
Streptococci	Resistant to all drugs	4	8%
Staphylococci	Resistant to all drugs	4	8%

 

         

Of all the 35 cases of cystitis subjected to urine culture and sensitivity, E. coli was seen in 27 cases and strepto and staphylococci were seen in 4 cases each. E. coli was sensi­tive to different drugs but strepto and staphylococci were resistant to all drugs and therefore, they were treated with 'Bangshil'.

 

TABLE X

Primary treatment

	Treatment	No. of Cases	%.
Senile hypertrophy of prostate	Enucleation	5	10%
Prostatitis	Indwelling catheter & bladder wash	8	16%
Stricture urethra	Dilatation & bladder wash	9	18%
Vesical calculus	Cysto-lithotomy	2	4%
Filarial cystitis	Bladder wash + antifilarial drugs	11	22%
Non-specific urethritis	Conservative treatment with Bangshil	15	30%

 

After this type of primary treatment to eradi­cate the aetiology, all of them were given a

course of `Bangshil' to control the secondary urinary tract infection.

 

TABLE-XI Therapeutic response of `Bangshil'
Types of cases	Dose schedule	Response
		Good	Fair	Poor
Post-Operative	2 tab T.I.D. 2 weeks	32%	8%	8%
Filariasis	1 tab. T.LD.3 weeks	16%	4%	2%
Non-specific urethritis	2 tab. T.LD. 4 weeks	22%	4%	4%
		70%	16%	14%

 

With the above dose schedule 70% showed good response, 16% fair response and in 14% of cases the effect was not quite appreciable.

 

DISCUSSION:­

The associated urinary tract infection in surgical conditions creates fear and anxiety, for reasons not known. And more so the obstructive lesions causing stasis, facilitate the growth and multiplication of different types of organisms, which become resistant to a particular drug, as found in the observations of many surgeons, urologists and gynecologists.

In this study, 24 patients with obstructive pathology were treated by different surgical procedures, along with 'Bangshil' which showed good response in 32% of cases, fair response in 8% of cases, and poor response in 8% cases. 11 cases of filariasis treated with both antifilarial drugs and `Bangshil', revealed good response in 16%, fair response in 4% and poor response in 2% of cases. 15 cases of non-specific urethritis were treated only with `Bangshil', which showed good response in 22% of cases, fair response in 4% of cases and poor in 4% of cases.

The type of response has been graded by clinical improvement, urine examination and culture and cystoscopy, after 6 weeks in each case and all of them were followed-up for 6 months. It was classified as good, with com­plete clinical improvement, clear urine, nega­tive culture and normal cystoscopy findings, fair, with marked clinical relief, clear urine, negative culture and less congestion in cys­toscopy; poor, with slight clinical improvement, less clear urine, resistant organisms in cul­ture; and persistent cystoscopy findings. Thus, overall, 70% revealed good response, 16% fair response, and 14% poor response in this series, suggesting the drug's high theraputic value in such conditions.

 

SUMMARY AND CONCLUSION:­

1) The therapeutic response of 'Bangshil' in 35 cases of cystitis and 15 cases of non­specific urethritis was studied.

2) Out of the 35 cystitis cases, 24 cases were associated with obstructive lesions where surgical intervention was done, and 11 cases of cystitis associated with filariasis were treated with antifilarial drugs.

3) `Bangshil' in appropriate doses was insti­tuted in all cases of cystitis and non­specific urethritis, irrespective of its culture and sensitivity report.

4) Its therapeutic response was assessed by repeated clinical check-ups, urine examina­tion and culture and cystoscopy. It was found to be good in 70% of the cases, fair in 16% cases and poor in 14% cases.

5) No untoward reactions were observed dur­ing this treatment.

 

ACKNOWLEDGEMENT

My sincere thanks are due to Dr. B.C. Agarwal, F.R.C.S., Assistant Professor of Urology, S.C.B. Medical College, Cuttack, for his kind help and guidance.

I wish to thank Mr. P.G. Shukla of Alarsin Pharmaceuticals, Bombay-400 001, for gener­ous supply of the drug and his co-operation in this trial and study.

 

REFERENCES:­

1. Walthers et al. (1968) : J. Urol, 79:1018.

2. Miller,C.P.  and Bohnhoft, M.J. (1966) : Amer, med. Assoc., 130:485.

3. Campbell, M.F. (1962): J. Amer, Med. Assoc., 99:2231.

4. Carrol et al. (1961) : J. Urol.; 62:574.

5. Herrold (1960) : J. Lab. Clin. Med., 35:205.
6. Braude et al. (1955) :J.Clin, Invest, 34:1489

 

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