An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine

doi:10.1016/j.ajur.2021.05.008

Asian Journal of Urology, 2022, 9 (2): 109-118 doi: 10.1016/j.ajur.2021.05.008

Review

Current Issue | Archive | Adv Search

An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine

Shabir Ahmad Bhat^*(

),Shameem Ahmad Rather,Naquibul Islam

Department of Moalajat, Regional Research Institute of Unani Medicine, Naseem Bagh, University of Kashmir, Srinagar, Jammu and Kashmir, India

Abstract
Related Citation (15)

Download:

HTML

PDF (1013KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Conventional treatments for benign prostatic hyperplasia (BPH) like 5alpha-reductase inhibitors and invasive surgery are associated with some obvious side effects. Conversely, evidence, though limited, has shown that alternative medicines are safer and have potential to improve the lower urinary tract symptoms (LUTS) and quality of life in addition to improving sexual dysfunction in patients with BPH. The current article aimed to include an overview of BPH, different ways of its management, and particularly its appreciation in Greco-Arab (Unani) system of medicine, one of the alternative medicinal systems.

Methods: PubMed, Scopus, ScienceDirect, Web of Sciences, Google Scholar databases and classical texts of Greco-Arab medicine were searched for data collection.

Results: In Unani system of medicine, BPH, traced under the headings of Waram unuq al-mathana (bladder neck swelling) and Insidad majra-i-mathana (bladder outlet obstruction), has been managed for centuries with herbal medicines yet demanding a comprehensive scientific validation. Among the herbs, Cucurbita pepo, Tribulus terrestris, Urtica dioica, and Linum usitatissimum are worth mentioning.

Conclusion: For achieving the goal of LUTS-free ageing men, and safer and cost-effective future management of BPH, Unani herbal medicine could hopefully prove beneficial.

Key words： Benign prostatic hyperplasia Herbal Lower urinary tract symptoms Tribulus terrestris Unani

Received: 29 April 2020 Available online: 20 April 2022

Corresponding Authors: Shabir Ahmad Bhat E-mail: drshabirbhat11.sb@gmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Shabir Ahmad Bhat
	Shameem Ahmad Rather
	Naquibul Islam

TRENDMD:

Cite this article:

Shabir Ahmad Bhat,Shameem Ahmad Rather,Naquibul Islam. An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine[J]. Asian Journal of Urology, 2022, 9(2): 109-118.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2021.05.008 OR http://www.ajurology.com/EN/Y2022/V9/I2/109

Relationship between benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), and lower urinary tract symptoms (LUTS) [12].

Pathophysiology of benign prostatic hyperplasia (BPH) [46].

Symptoms of benign prostatic hyperplasia.

BPH in modern and Greco-Arab (Unani) system of medicine.

Intra- and intergroup comparison of test drug vs. control in three different clinical trials.

Percentage of symptom improvement with test drug and control in three different clinical trials.

[1]	Das S. A concise text book of surgery. Kolkata: Dr Somen Das; 2014. p1271-4.
[2]	Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am 2011; 95:87-100. doi: 10.1016/j.mcna.2010.08.013
[3]	Girman CJ, Jacobsen SJ, Rhodes T, Guess HA, Roberts RO, Lieber MM. Association of health-related quality of life and benign prostatic enlargement. Eur Urol 1999; 35:277-e84.
[4]	McNeal JE. Regional morphology and pathology of the prostate. Am J Clin Pathol 1968; 49:347e57.
[5]	Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984; 132: 474e9.
[6]	Untergasser G, Madersbacher S, Berger P. Benign prostatic hyperplasia: Age-related tissue-remodeling. Exp Gerontol 2005; 4:121-8.
[7]	Epstein JI, Lotan TL. Male genital article-title. In: Kumar V, Abbas AK, Aster JC, editors. Robins basic pathology. Philadelphia: Elsevier Health Sciences Division; 2017. p698-9.
[8]	Roehrborn CG, 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. Philadelphia: Saunders; 2002. p1297-336.
[9]	Foster HE, Barry MJ, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guidelines. J Urol 2018; 200:612-9. doi: 10.1016/j.juro.2018.05.048
[10]	Van Ruiswyk J. Benign prostatic hypertrophy. In: Torre DM, Lamb GC, Van Ruiswyk J, Schapira RM, editors. Kochar’s clinical medicine for students. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 844.
[11]	McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349: 2387-98. doi: 10.1056/NEJMoa030656
[12]	Hald T. Urodynamics in benign prostate hyperplasia: A survey. Prostate Suppl 1989; 2:69-77. pmid: 2482774
[13]	Roehrborn CG. Benign prostatic hyperplasia: An overview. Rev Urol 2005; 7:S3e14. PMID: 16985902.
[14]	Shelley HS. The enlarged prostate: A brief history of its treatment. J Hist Med Allied Sci 1962; 24:452-73.
[15]	Harry WH. The enlarged prostate: A brief history of its surgical treatment. BJU Int 2006:947-52.
[16]	Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis. Sci Rep 2017; 7: 7984. https://doi.org/10.1038/s41598-017-06628-8. doi: 10.1038/s41598-017-06628-8
[17]	Yeboah E. Prevalence of benign prostatic hyperplasia and prostate cancer in Africans and Africans in the diaspora. J West Afr Coll Surg 2016; 6:1-30.
[18]	Saigal CS, Joyce G. Economic costs of benign prostatic hyperplasia in the private sector. J Urol 2005; 173:1309-13. doi: 10.1097/01.ju.0000152318.79184.6f
[19]	Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: Benign prostatic hyperplasia. J Urol 2008; 179: S75-80. https://doi.org/10.1016/j.juro.2008.03.141.
[20]	Chung SD, Tzeng YM, Lin HC, Huang CY. Healthcare utilization and costs in patients with benign prostatic hyperplasia: A population-based study. Asian J Androl 2016; 18:942-5.
[21]	Bosch JL, Tilling K, Bohnen AM, Bangma CH, Donovan JL. Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: Prediction of future prostate volume in individual men. Prostate 2007; 67:1816-24. pmid: 17935157
[22]	Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC. Prostate volume changes over time: Results from the Baltimore longitudinal study of aging. J Urol 2009; 182: 1458-62. doi: 10.1016/j.juro.2009.06.047
[23]	Jin B, Turner L, Zhou Z, Zhou EL, Handelsman DJ. Ethnicity and migration as determinants of human prostate size. J Clin Endocrinol Metab 1999; 84:3613-9.
[24]	Ganpule AP, Desai MR, Desai MM, Wani KD, Bapat SD. Natural history of lower urinary tract symptoms: Preliminary report from a community-based Indian study. BJU Int 2004; 94: 332-4.
[25]	Giri A, Edwards TL, Motley SS, Byerly SH, Fowke JH. Genetic determinants of metabolism and benign prostate enlargement: Associations with prostate volume. PloS One 2015; 10: e0132028. https://doi.org/10.1371/journal.pone.0132028. doi: 10.1371/journal.pone.0132028
[26]	Pearson JD, Lei HH, Beaty TH, Wiley KE, Isaacs SD, Isaacs WB, et al. Familial aggregation of bothersome benign prostatic hyperplasia symptoms. Urology 2003; 61:781-5. pmid: 12670565
[27]	Sanda MG, Doehring CB, Binkowitz B, Beaty TH, Partin AW, Hale E, et al. Clinical and biological characteristics of familial benign prostatic hyperplasia. J Urol 1997; 157:876-9. pmid: 9072590
[28]	Nishant D, Patel, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol 2014; 30:170-6. doi: 10.4103/0970-1591.126900
[29]	Frick J, Aulitzky W. Physiology of the prostate. Infection 1991; 9:S115e8. https://doi.org/10.1007/bf01643679.
[30]	Nicholson TM, Ricke WA. Androgens and estrogens in benign prostatic hyperplasia: Past, present and future. Differentiation 2011; 82:184-99. doi: 10.1016/j.diff.2011.04.006 pmid: 21620560
[31]	Lee KL, Peehl DM. Molecular and cellular pathogenesis of benign prostatic hyperplasia. J Urol 2004; 172:1784-91. doi: 10.1097/01.ju.0000133655.71782.14
[32]	Carso 3rd C, Rittmaster R. The role of dihydrotestosterone in benign prostatic hyperplasia. Urology 2003; 61:2-7.
[33]	Wright AS, Thomas LN, Douglas RC, Lazier CB, Rittmaster RS. Relative potency of testosterone and dihydrotestosterone in preventing atrophy and apoptosis in the prostate of the castrated rat. J Clin Invest 1996; 98:2558-63. pmid: 8958218
[34]	Meikle AW, Stringham ID, Olsen DC. Subnormal tissue 3-a androstanediol and androsterone in prostatic hyperplasia. J Clin Endocrinol Metab 1978; 47:909-13. doi: 10.1210/jcem-47-4-909
[35]	Geller J, Albert J, Lopez D, Geller S, Niwayama G. Comparison of androgen metabolites in benign prostatic hypertrophy (BPH) and normal prostate. J Clin Endocrinol Metab 1976; 43:686-8. doi: 10.1210/jcem-43-3-686
[36]	Hammond GL. Endogenous steroid levels in the human prostate from birth to old age: A comparison of normal and diseased states. J Endocrinol 1978; 78:7-19. pmid: 79632
[37]	Kreig MW, Bartsch W, Janssen W, Voigt KD. A comparative study of binding metabolism and endogenous levels of androgen in normal, hyperplastic and carcinomatous human prostate. J Steroid Biochem 1979; 11:615-24. doi: 10.1016/0022-4731(79)90090-6
[38]	Van der Sluis TM, Vis AN, Moorselaar RJ, Bui HN, Blankenstein MA, Meuleman EJ, et al. Intraprostatic testosterone and dihydrotestosterone. Part I: concentrations and methods of determination in men with benign prostatic hyperplasia and prostatic cancer. BJU Int 2012; 109:176-82. doi: 10.1111/j.1464-410X.2011.10651.x pmid: 21992222
[39]	Vickman RE, Franco OE, Moline DC, Vander Griend DJ, Thumbikat P, Hayward SW. The role of androgen receptor in prostate development and benign prostatic hyperplasia: A review. Asian J Urol 2020; 7:191-202. doi: 10.1016/j.ajur.2019.10.003 pmid: 32742923
[40]	Ajayi A, Abraham K. Understanding the role of estrogen in the development of benign prostatic hyperplasia. Afr J Urol 2018; 24:93-7. doi: 10.1016/j.afju.2018.01.005
[41]	Wu Y, Pan H, Wang WM, Xu D, Zhang L, Qi J, et al. A possible relationship between serum sex hormones and benign prostatic hyperplasia/lower urinary tract symptoms in men who underwent transurethral prostate resection. Asian J Androl 2017; 19:230-3. doi: 10.4103/1008-682X.171575
[42]	Chughtai B, Lee R, Te A, Kaplan S. Role of inflammation in benign prostatic hyperplasia. Rev Urol 2011; 13:147-50. pmid: 22110398
[43]	Kruslin B, Tomas D, Dzombeta T, Milkovic-Perisa M, Ulamec M. Inflammation in prostatic hyperplasia and carcinomadbasic scientific approach. Front Oncol 2017; 7:77. https://doi.org/10.3389/fonc.2017.00077. doi: 10.3389/fonc.2017.00077
[44]	De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nat Rev Urol 2016; 13:613-26. doi: 10.1038/nrurol.2016.168
[45]	Lucia MS, Lambert JR. Growth factors in benign prostatic hyperplasia: Basic science implications. Curr Urol Rep 2008; 9: 272-8. doi: 10.1007/s11934-008-0048-6
[46]	Lepor H. Pathophysiology of benign prostatic hyperplasia in the aging male population. Rev Urol 2005; 7:S3e12. PMID: 16986052.
[47]	Foo KT. Pathophysiology of clinical benign prostate hyperplasia. Asian J Urol 2017; 4:152-7.
[48]	Lee CL, Kuo HC. Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts. Tzu Chi Med J 2017; 29:79-83.
[49]	Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: Report from the standardization subcommittee of the International Continence Society. Neurology Urodyn 2002; 21:167-78.
[50]	Mukamel E, Nissenkorn L, Boner G, Servadio C. Occult progressive renal damage in the elderly male due to benign prostatic hypertrophy. J Am Geriatr Soc 1979; 27:403-6. pmid: 89133
[51]	Liao L, Chuang YC, Liu SP, Lee KS, Yoo TK, Chu R, et al. Effect of lower urinary tract symptoms on the quality of life and sexual function of males in China, Taiwan, and South Korea: Subgroup analysis of cross-sectional, population-based study. Low Urin Tract Symptoms 2019; 11:O78-84. https://doi.org/10.1111/luts.12220.
[52]	Luo GC, Foo KT, Kuo T, Tan G. Diagnosis of prostate adenoma and the relationship of its site to bladder outlet obstruction. Singapore Med J 2013; 54:482-6. doi: 10.11622/smedj.2013168
[53]	Barry MJ, Fowler FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American urological association symptom index for benign prostatic hyperplasia. J Urol 2017; 197: S189e97. https://doi.org/10.1016/j.juro.2016.10.071.
[54]	Gravas S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of non-neurogenic male lower urinary tract symptom (LUTS), incl. benign prostatic obstruction (BPO): EAU guidelines. Eur Assoc Urol 2020. https://uroweb.org/guidelines/compilations-of-all-guidelines/. [Accessed 6 June 2020].
[55]	El-Zawahry A, Alanee S, Malan-Elzawahry A. The use of urodynamics assessment before the surgical treatment of BPH. Curr Urol Rep 2016; 17:73. https://doi.org/10.1007/s11934-016-0626-y.
[56]	Eri LM, Wessel N, Berge V. Test-retest variation of pressure flow parameters in men with bladder outlet obstruction. J Urol 2001; 165:1188-92. pmid: 11257668
[57]	Oelke M, Martinelli E. Medikamentose therapie des benignen prostatasyndroms [pharmacological treatment of benign prostatic hyperplasia]. Urologe 2016; 55:81-96. [Article in German]. doi: 10.1007/s00120-015-0011-3
[58]	Chung ASJ, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol 2018; 5:22-7.
[59]	Srinivasan A, Wang R. An update on minimally invasive surgery for benign prostatic hyperplasia: Techniques, risks and efficacy. World J Mens Health 2019; 37:-48. https://doi.org/10.5534/wjmh.190076.
[60]	Braeckman J, Denis L. Management of BPH then 2000 and now 2016dfrom BPH to BPO. Asian J Urol 2017; 4:138-47. doi: 10.1016/j.ajur.2017.02.002 pmid: 29264222
[61]	Shrivastava A, Gupta VB. Various treatment options for benign prostatic hyperplasia: A current update. J Midlife Health 2012; 3:10-9. doi: 10.4103/0976-7800.98811 pmid: 22923974
[62]	Cicero AFG, Allkanjari O, Busetto GM, Cai T, Larganà G, Magri V, et al. Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer. Arch Ital Urol Androl 2019; 91. https://doi.org/10.4081/aiua.2019.3.139.
[63]	Paital B, Hati AK, Nanda LK, Mishra AK, Naik C. Combined effects of constitutional and organopathic homeopathic medicines for better improvement of benign prostatic hyperplasia cases. Int J Clin Med Images 2017; 4:574. https://doi.org/10.4172/2376-0249.1000574.
[64]	Tarique M, Ali T. A comparative study of efficacy and safety of a Unani formulation with the currently available drugs (tamsulosin and finasteride) in the management of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia. Int J Sci Res 2020; 9:66-7.
[65]	Zang W, Wang X, Liu Y, Tian H, Flickinger B, Empie M, et al. Effects of dietary flaxseed lignin extract on symptoms of benign prostatic hyperplasia. J Med Food 2008; 11:207-14. doi: 10.1089/jmf.2007.602
[66]	Vahlensieck W, Theurer C, Pfitzer E, Patz B, Banik N, Engelmann U. Effects of pumpkin seeds in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year randomized, placebo-controlled GRANU study. Urol Int 2015; 94:286-95. doi: 10.1159/000362903 pmid: 25196580
[67]	Zhang W, Ma L, Bauer BA, Liu Z, Lu Y. Acupuncture for benign prostatic hyperplasia: A systemic review and metaanalysis. PloS One 2017; 12:e0174586. https://doi.org/10.1371/journal.pone.0174586. doi: 10.1371/journal.pone.0174586
[68]	Ibn Zuhr AM. Amrāz kuliya wa mathana. In: Ahmad B, editor. Kitāb al-Taisīr fil madāwāt wal tadbīr. New Delhi: Central Council for Research in Unani Medicine; 1986. p164-6.
[69]	Sina SR. Amrāz juz’ia. In: Kantori GH, editor. translator. Alqanoon fil tib. New Delhi: Ejaz publishing house; 2010. p1018-30.
[70]	Jurjani AH. Amrāz mathana. In: Khan HH, editor. translator. Zakhīra khwarzam shahi. New Delhi: Idara Kitābul Shifa; 2010. p525-31.
[71]	Razi ABZ. Amrāz minal qarn elal qadam. In: CCRUM, editor and translator. Kitābul hāwī fil tib. New Delhi: Central Council for Research in Unani Medicine; 2002. p148-78.
[72]	Ahmad SI. Kulliyat-i-Asri, Umoor-i-tabiya. New Delhi: New public press; 1983. p9, 184.
[73]	Khan MA. Amrāz mathana. In: Kabiruddin M, editor. Aksīr-i- Azam. New Delhi: Ejaz publishing house; 2010. p728-34.
[74]	Al-Qumri AMH. Usr al-bawl and ihtibas al-bawl. In: CCRUM, editor and translator. Ghina wa Muna. New Delhi: Central Council for Research in Unani Medicine; 2008. p304-10.
[75]	Arzani A. Mathana ke makhsūs amrāz. In: Siddiqui MH, editor. translator. Tibb-i-Akbar. Lucknow. Munshi Nawal Kishore; 1925. p411-5.
[76]	Ibn al-Quff AAF. Amrāz balghami and qurūh wa dubailāt ka ilāj. In: Farooqi TH, editor. Kitābul Umda fil Jarahat. vol. 37. New Delhi: Central Council for Research in Unani Medicine; 1986. p22, 69, 232.
[77]	Al-Zahrawi AQ. Mathana me rukey huey peshab ka ilāj. In: Kakori NA, editor. translator. Jarahiyāt Zahrawi. New Delhi: Central Council for Research in Unani Medicine; 2012. p. 107.