[Current Medical Practice (1992): (36), 7, 179] Speman in Benign Hypertrophy of the Prostate (B.H.P.) – A Final Report Mohammad Hadi Sheikhai, M.B.B.S. and Maji, B.P., M.B.B.S. (Cal.), M.S. (Cal.), F.R.C.S. (Edin.), F.I.C.G., F.C.C.P. (U.S.A.), F.I.C.S. (Chicago), Associate Professor, Urology Unit, Department of Surgery, I.P.G.M.E. & R., S.S.K.M. Hospital, Calcutta, India. ABSTRACT A 6-month trial of Speman on 82 patients aged between 50-85 years with benign hypertrophy of the prostate (BHP) was undertaken at the hospital. The dose of Speman was 2 tablets, t.i.d., for 6-8 weeks. Eighteen operated patients were followed up in the indoor department, and the remaining 64 at the OPD. Intravenous pyelography (IVP) and Cystoscopy were done before and after treatment in 35 and 26 patients respectively. Marked improvement in symptoms was noted specially in regard to frequency and dysuria. In mild to moderate BHP, regular Speman therapy does postpone the need for urgent operation. In advanced cases, chances of acute retention and frequent catheterization are reduced. Speman has proved an effective and safe remedy for BHP. INTRODUCTION Benign hypertrophy of the prostate (BHP) is a fairly common condition met within our Urology Department. There is a wide range of symptoms with which the patient may present. In this six month clinical trial, started in January 1988, we have studied the symptomatic relief obtained in eighty two (82) patients of BHP on taking Speman at a dose of two tablets t.i.d. for a period of six to eight weeks. TYPES OF CASES The patients were aged between 50 to 85 years. Most of them suffered from mild to moderate BHP. Some, however, were in an advanced stage. Eighteen (18) of those who were operated upon were followed up from the indoor department, while the remaining 64 were followed up from the outpatient department of the Urology unit of our hospital. DOSAGE For new cases: Two tablets of Speman, t.i.d. for 6 to 8 weeks. For follow-up cases: One tablet of Speman t.i.d. for 6 to 8 weeks. The total duration of therapy with Speman tablets was 2 tablets thrice a day for 6 to 8 weeks in the majority of cases and in a few cases 12 to 16 weeks. SYMPTOMS AND SIGNS Patients with BHP commonly present with the following symptoms: Increased frequency of micturition, particularly at night Dysuria Urgency Delay in initiation of micturition Dribbling and poor flow Haematuria Lower abdominal pain. And last, but not least, acute or chronic retention of urine. Amongst the signs, the most valuable are the findings obtained on rectal examination. INVESTIGATIONS In all patients a complete history was taken and thorough physical examination done. Samples of blood, urine and stool were sent for routine laboratory tests. Those showing presence of pus cells and red blood corpuscles (RBCs) in the urine had urine culture and sensitivity done as well. Intravenous Urography (IVU) was done before and after treatment in thirty five (35) patients. Cystoscopy was done before and after treatment in twenty six (26) patients. Operated specimens were sent for histopathological examination. OBSERVATIONS AND DISCUSSION Observations were made under the following headings: AImprovement in symptoms BImprovement in signs CChanges in urine report DChanges in IVU EChanges in cystoscopic findings FHistopathological reports A- Improvement in symptoms in sixty four (64) patients treated with Speman over a 12 to 16 week period is shown in Table 1. Table 1: Improvement in symptoms No. of patients before treatment No. of patients after treatment Frequency 60 43 (72%) Dysuria 46 32 (70%) Urgency 41 28 (68%) Delay in initiation 54 34 (63%) Poor flow 60 41 (68%) Haematuria 15 8 (53%) Pain in the abdomen 10 7 (70%) Retention of urine 25 17 (68%) Symptoms B- Improvement in signs was observed on rectal examination in thirty nine (39) out of sixty four (64) patients (61%). The criteria were the prostatic size, consistency and amount of residual urine in the post-prostatic pouch. Continuous drainage of the bladder by a catheter was no longer necessary in six out of ten (60%) cases of acute retention. C- Changes in urine reports of fifty seven (57) patients after treatment were as shown in Table 2. Suitable antibiotics were used whenever the urine examination showed a positive culture. Table 2: Changes in urine reports No. of cases before treatment No. of improved cases after treatment No change Pus cells present 45 39 (87%) 6 RBCs present 21 16 (76%) 5 38 36 (95%) 2 Investigation Urine: Urine culture with significant growth of pathogens D- IVU was done in thirty five cases before and after treatment. Of these, twenty two (63%), showed a marked reduction in residual urine after evacuation of the bladder. E- Cystoscopy was done before and after treatment in twenty six cases. Fifteen (58%) of these showed reduced congestion of the prostatic urethra and sixteen (62%) showed decreased residual urine. F- Specimens from the eighteen operated cases were sent for histopathological examination. Fifteen showed adenomatous enlargement and three showed latent carcinoma of the prostate. SIDE EFFECTS Follow-up of all the cases did not reveal any side effects during treatment with Speman. CONCLUSIONS In this six-month long trial period with Speman we have endeavoured mainly to observe the symptomatic relief obtained in 82 patients of BHP, on taking the recommended dose of Speman for 6 to 8 weeks and in a few cases for 12 to 16 weeks. We found a good number of cases showing marked improvement in symptoms, especially with regard to frequency and dysuria. In mild to moderate cases regular administration of Speman dose seem to reduced the symptoms and helps postpone the need for urgent operation. In advanced cases it reduces the chances of acute retention and the need for frequent catheterization. It also probably diminishes pre-operative blood loss by reducing prostatic congestion. How far it affects the complex cellular components of the gland is yet to be investigated. From our trial we can say that Speman is an effective and safe remedy in the treatment of BHP, especially in the mild to moderate stages.