Prostatectomy in Ayurveda: A Conceptual and Surgical Review Based on Sushruta’s Perineal Approach in Ashmari Chikitsa

Abstract

The prostate gland, though unnamed in classical Ayurvedic texts, occupies a pivotal role in modern urology, particularly in the surgical management of obstructive lower urinary tract conditions. This study aims to reinterpret Sushruta’s operative methodology through the lens of contemporary anatomical knowledge and evaluate whether his technique represents an early form of prostate-region surgery. The classical passage outlines patient preparation with oleation, sudation, and ritual measures, followed by precise positioning over a support person. Sushruta then describes accessing the urinary tract through the Payu–medhra antaram, the perineal space which, according to modern pelvic anatomy, provides a direct corridor to the prostate and bladder neck. His emphasis on palpating a “Granthi-like” elevation suggests recognition of a glandular or obstructive mass consistent with an enlarged prostate or impacted calculus. The technique further involves digital guidance, controlled dissection, and assessment of neurological signs prior to extraction principles echoed in modern perineal prostatectomy. By comparing Sushruta’s approach with contemporary urological literature, significant similarities emerge in the surgical pathway, tactile localization, and caution against operating under signs of hemodynamic collapse. This suggests that the foundational concepts of prostate-region surgery were present in ancient India nearly two millennia before the documented Western innovations. This reinterpretation not only underscores the sophistication of Ayurvedic surgical knowledge but also proposes that Sushruta’s description may represent the earliest historically documented precursor to perineal prostatectomy. Recognizing this connection enriches both Ayurvedic scholarship and the global history of urological surgery, emphasizing the need for continued interdisciplinary research.