CC BY
31
Pathological changes were observed in a vascular channel and shown — arteriospazm, aterozum, a thrombosis of vessels bazal plates, perifocal necrosis dicedual fabrics. It was marked complete blood interfleecy space, came to light erythrocytes of stasis and extensive diapedesis hemorrhages in строме intermediate and terminal villus. Presence of the central heart attacks in functionally active cotyledon the central and paracentral zones, testified to progressing flow of placentary insufficiency.
Along with placenta heart attacks formation of the interfleecy blood clots hemorrhages from vessels villus chorion were which reason was marked. Hemorrhages were as очаговые, and diffuse that corresponded to formation of small interfleecy blood clots. At long enough existence of interfleecy blood clots there were signs ofviolation of blood circulation and a dystrophy in villusax chorion with occurrence fibrinoides.
Conclusion: PPS it is combined with true heart attacks that testifies about causation generality of these pathological processes. Hyperactivation thrombocytes and increase coagulation potential against depressing antiposset gears, lead to development of thromboses and heart attacks in a placenta, provoke development hypoperfusion and placentary insufficiency. PPS it is possible to attribute to sharp vascular violations as in a microscopic picture placenta heart attacks, thromboses ofvessels of a placenta, a placentary bed, spiral arteries take place. The formation microthrombosis and microcirculation violations play an essential role in a pathology of spiral arteries and development obstetric the complications connected with change of maternal-placentary blood circulation. Thrombophilia it is indisputable associated with vascular placentary pathologies.
References:
1. Абдуллаходжаева М. С., Кхваджа С. Характеристика маточно-плацентарного комплекса при полной отслойке нормально расположенной плаценты на фоне ЕРН-гестоза и анемии беременных.//Арх.патол. - 2007. - № 1. - C. 17-23.
2. Воднева Д. Н., Романова В. В. Клинико-морфологические особенности ранней и поздней преэклампсии//Акуш. и гин. - 2014. -№ 2. - С. 35-39.
3. Маматкасимов Э. М., Юлдашева Ш. Ф. Морфологические изменения плаценты при фетоплацентарной недостаточности у беременных женщин//Новости дерматологии и репродуктивного здоровья. - 2014. -№ 3. - С. 45-49.
4. Милованов А. П. и др. Патологоанатомическое изучение последа: Методические рекомендации. - М.: Медицина - 2008. - 62 с.
5. Ananth C. V., Getahun D., Peltier M. R. Placental abruption in term and preterm gestations: evidence for heterogeneity in clinical pathways.//Obstet Gynecol. - 2006. - Vol. 107 (4). - P. 785-92.
6. Dafallah SE, Babikir H. E. Risk factors predisposing to abruptio placentae. Maternal and fetal outcome//Saudi Med J. - 2004. - Vol. 25 (9). - P. 1237-40.
7. Hoffmann E., Hedlund E., Perin T. Is thrombophilia a risk factor for placenta-mediated pregnancy complications?//Arch Gynecol Obstet. - 2012. - Vol. 28.
8. Messerli M., May K. et al. Feto-maternal intervactions in pregnancies: placental microparticles activate peripheral blood mono-cytes.//Placenta. - 2010. - Vol. 31 (2). - P. 106-112.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-140-144
Khudaybergenov Ulugbek Ataullaevich, Tashkent Medical Academy, PhD in Medical Sciences, Faculty of Treatment E-mail: ulugbek0465@gmail.com Akilov Farkhad Ataullaevich, Republican Specialized Center of Urology, Doctor of Sciences in Medicine, Professor, Tashkent, Uzbekistan
E-mail: nepster1984@inbox.ru Makhmudov Azamjon Talatovich, Tashkent Medical Academy, Doctor of Sciences in Medicine, Faculty of Treatment E-mail: azamjon.makhmudov@gmail.com Tukhtamishev Muzaffar Khikmatovich, Tashkent Medical Academy, Assistant Lecturer, Faculty of Treatment E-mail: muzaffaruro@gmail.com
Studying of prevalence of the most significant urological diseases in the Aral Sea Area
Abstract: This article has enlightened the issues of study of prevalence indicators of the most significant urological diseases in the Aral Sea Area in the environment of initial link health services. Survey has been conducted in four rural-medical centers of the region. In order to carry out the inspection the representative sampling has been formed, where the both gender
personalities of the age of 1 year and older were included. In total 7597 people has been inspected that made 85,4% of the number subject to inspection. As a result of epidemiologic survey the level of true illness level of the population in the Aral Sea Area was established on certain nosological forms of urologic diseases. The analysis has shown that the most widespread among the population is the urine tract infection (10,75±0,36), followed by pre-lithiasis (5,82±0,27), BPH (3,37±0,21) and urolithiasis (1,40±0,13) per 100 surveyed. It should be noted that in no case the comparison of prevalence rate of urological diseases in Khorezm region and in the Republic of Karakalpakstan has revealed significant territorial indicators differences (p>0,05). Big importance in conduction of epidemiologic survey is given to involving to its fulfillment of initial health care link (general patricians), as the most approached and having the possibility to carry out the early diagnostics of urological diseases.
Keywords: prevalence of urological disease, early diagnostics of urological diseases, urolithiasis, benign prostatic hyper-plasia, urinal tract infection.
Introduction
Data of the researches devoted to prevalence of illnesses of genitourinary sphere, concerns only separate nosological units or, as a last resort, their groups. Researches of prevalence of urolithiasis, benign prostatic hyperplasia (BPH), urinary tract infections (UTI), carried out at various times in many countries, in some extent and scale [1, 4-11; 4, 1150-1159] relate to them. Coverage of the data on the prevalence of diseases estimated on appealability of patients for the medical aid can be much wider, therefore objectivity of such data is relative, as appealability, in itself, depends on many factors (availability of medical aid, its quality, sanitary culture of the population, its mentality, etc.) and to present an integrated picture of true prevalence of diseases of organs of urinary ways and man's sexual sphere, not always is obviously possible.
Meanwhile, urological diseases, especially most significant of them — urolithiasis, UTI, BPH, widespread, reduce quality of life and cause disability in patients, demand the big expenses for treatment and after treatment and, as a result, turn around an essential material damage in Republic scales [3,3-6; 5,36-37; 7, 82-95].
For a situation assessment related to urological case rate, modern data on it, both according to the official statistical reporting, and by results of specially conducted epidemiological researches among the population is necessary.
The researches executed last years, including in Uzbekistan, have made the certain contribution to the resolution of a studied question [6, 20; 8, 41; 9, 37]. However, it is necessary to notice that a studying subject were only separate aforementioned nosological units and their groups [2, 36-38; 3, 3-6].
Other not studied aspect of a surveyed problem is definition of possibilities and a share ofparticipation of a primary link ofmedical aid (general practitioner) in control ofurological case rate. Planned research is localized in the Aral Sea Area which is a zone of ecological catastrophe and where it is necessary to give particular attention to the state of the population health, as well as to diagnostics of early stages of diseases, by elaboration of both medical, and preventive actions that in a bigger extent is connected with the activity of a primary link of public health services.
The purpose of work — an assessment of prevalence indicators of the most significant urological diseases in environmentally adverse Aral Sea Area.
Materials and methods
Epidemiological research by cross-sectional study is carried out among the population served by rural-medical centre (RMC) "Avaz Utar" ofYangiaryk district and RMC "Uygur" ofYangibazar district of Khorezm region. In the Republic of Karakalpakstan are chosen RMC "Kirkkiz" of Ellikkala district and RMC "Cheremushka" of Nukus district. The population of the specified sites is surveyed by a continuous method.
The Republic Karakalpakstan and Khorezm region can be defined as the territories different on a complex of geographical (ecological) characteristics not only in the Republic of Uzbekistan, but also as a whole, in Central Asian region.
For research carrying out, a representative sample where persons ofboth sexes at the age from 1 year and older have been included has been generated. The population selected for epidemiological research represented a contingent of the countrymen, actually all life lived in the given area.
The case rate on appealability not always shows true level of diseases prevalence available for the population. It is known that a certain part of the population suffering chronic diseases, for whatever reasons do not address for medical aid though are in great need in it. In this connection to establish real prevalence of chronic diseases at the population according to appealability and current observation is often impossible. Based on this, for an assessment of true level of a case rate, in 2009-2011, employees of chair of urology of the Tashkent medical academy and the Republican specialized center of urology (RSCU) have organized an expedition. Together with general practitioners in the chosen sites complex medical examination of7597 persons that has made 85,4% of the number subject to survey has been conducted.
At distribution of the population structure on gender and age groups, for the analysis of separate urological diseases we had been used the international classification of diseases — ICD-10 (1993) (Table 1).
Sex Male Female Total
Age n % n % n %
1 2 3 4 5 6 7
1-14 867 29,3 821 17,7 1688 22,2
15-19 293 9,9 482 10,4 775 10,2
20-29 469 15,8 1118 24,1 1587 20,9
30-39 484 16,4 882 19,0 1366 18,0
40-49 345 11,7 713 15,4 1058 13,9
50-59 264 8,9 439 9,5 703 9,3
60-69 132 4,5 109 2,4 241 3,2
Table 1. - Distribution of the surveyed population on gender and age
1 2 3 4 5 6 7
70-79 91 3,1 66 1,4 157 2,1
>80 15 0,5 7 0,2 22 0,3
Total 2960 39,0 4637 61,0 7597 100,0
As it is seen on the table, the number of children, in total, has made 1688 (22,2%), persons of youthful age — 775 (10,2%). The overwhelming majority patients at the age from 20 till 69 years — 4955 (have made 65,2%), over this age — 179 (2,7%).
The universal questionnaire was applied to population inspection intended for definition of symptoms inherent to urological diseases specially developed in the Republican specialized center of urology. The questionnaire includes 33 questions concerning symptoms of the bottom urinary tract, infections of an urinary tract, an incontinence of urine, a pathology of man's sexual sphere. General practitioners of a primary link ofpublic health services actively participated together with RSCU doctors in inspection of the population and questionnaire filling and conducted the physical survey of respondents.
With a view of screening ofurological diseases ultrasonic scanner "Kransbuhler" (Germany), with 3.5 MHz convex gage was used. At ultrasonic scanning (USS) of organs of urinary system paid attention to morphological changes of pyelocaliceal system and a parenchyma of kidneys (hydronephrosis, hydrocalycosis, cystic formations, tumors, etc.), ascertained signs of stones and salts conglomerates in kidneys cavities.
Table 2. - Prevalence of separate urological
Urine analyses were carried out by a quick test by using of teststrips Urine-10 ("Cypress Diagnostics"). Microscopy of urine sediment was carried out when necessary.
BPH screening at men over the age of 50 was carried out using the following methods: poll of respondents on universal questionnaire, with filling of the questionnaire of the international assessment system of prostate disease symptoms; physical survey including external examination of organs of a scrotum and digital rectal examination of a prostate; ultrasonic research of kidneys, urinary ways and a prostate with an assessment of presence and volume of a residual urine, scoping of a prostate and an average flow rate of urine.
All patients, under the specified list, were invited to survey and inspection by special authorized employees of RMC. Control of the given procedure was carried out in interaction with local administration and a management of treatment-and-prophylactic establishments of the district. Outcomes & discussion
Prevalence of the most significant urological diseases in the Aral Sea Area has made 21,34±0,47 for 100 surveyed, in Khorezm region — 21,02±0,64 cases, in Republic Karakalpakstan — 21,69±0,69 cases for 100 surveyed (Table 2).
diseases in the Aral Sea Area (on 100 surveyed)
Diseases Khorezm region Republic of Karakalpakistan Average
Pre-lithiasis 5,51±0,36 6,16±0,40 5,82±0,27
Urolithiasis 1,65±0,20 1,11±0,17 1,40±0,13
UTI 10,85±0,49 10,65±0,51 10,75±0,36
BPH 3,01±0,27 3,77±0,32 3,37±0,21
Total 21,02±0,64 21,69±0,69 21,34±0,47
The analysis of level of a true case rate of the population in the Aral Sea Area under separate nosological forms of urological diseases has shown that among the population the infection of an urinary tract (10,75±0,36) is most extended, it follows pre-lithiasis (5,82±0,27), BPH (3,37±0,21) and urolithiasis (1,40±0,13). It is
necessary to notice that in one case, comparison of level of prevalence of urological diseases in Khorezm region and Republic Karakalpakstan has not taped significant territorial differences of indicators (p>0,05) (Table 3).
Table 3. - Prevalence of separate urological diseases in the Aral Sea Area depending on gender (on 100 surveyed)
Khorezm region Republic of Karakalpakistan Totally
Diseases male female P male female P male female P
Pre-lithiasis 5,37±0,57 5,61±0,47 >0,05 7,22±0,69 5,47±0,49 <0,05 6,25±0,44 5,54±0,34 >0,05
Urolithiasis 1,87±0,34 1,51±0,25 >0,05 1,27±0,30 1,00±0,21 >0,05 1,59±0,23 1,27±0,16 >0,05
UTI 5,04±0,56 14,53±0,71 <0,001 4,03±0,52 14,91±0,76 <0,001 4,56±0,38 14,71±0,52 <0,001
BPH 7,63±0,67 9,13±0,77 8,34±0,51
Total 20,04±1,02 21,64±0,83 >0,05 22,15±1,10 21,39±0,88 >0,05 21,05±0,75 21,52±0,60 >0,05
The analysis of level of a true case rate of the population of Khorezm region and Republic Karakalpakstan on patients' gender has shown that prevalence of urinary tract infection has appeared higher with women, than those with men. In Khorezm region women's UTI met more often 2,9 times, in Republic Karakalpakstan — 3,7 times that can be explained by anatomico-physiological features of genitourinary organs of women.
In Republic Karakalpakstan, there was above a prevalence of pre-lithiasis indicator with men — 7,22±0,69, with women it has made 5,47±0,49.
It is necessary to notice that if at the age of1-14 the prevalence of urological diseases on 100 surveyed has made 6,87±0,62, then with persons of 80 years and older their level is made already 90,91±6,13 (tab. 4). Sharp increase of a case rate level was noticed in age group of 60-69 years. If with persons of 50-59 years, case rate level in comparison with age group of 1-14 years is enlarged in 5,6 times, at the age of 60-69 years it was enlarged more than 9 times. In Khorezm region accordingly indicators were enlarged 5,2 and 8,8 times, and in Republic Karakalpakstan — 6,3 and 9,9 times.
Table 4. - Prevalence of urological diseases in the Aral Sea Area depending on age of the surveyed (on 100 surveyed)
Age Khorezm region Republic of Karakalpakistan Totally
1-14 7,52±0,85 6,00±0,89 6,87±0,62
15-19 12,50±1,58 12,54±1,81 12,52±1,19
20-29 19,73±1,40 17,01±1,35 18,40±0,97
30-39 20,11±1,52 20,30±1,55 20,20±1,09
40-49 25,69±1,88 28,63±1,99 27,13±1,37
50-59 39,29±2,66 37,87±2,53 38,55±1,84
60-69 66,02±4,67 59,42±4,18 62,24±3,12
70-79 76,83±4,66 65,33±5,50 71,34±3,61
>80 81,82±11,63 100,00±0,00 90,91±6,13
Total 21,02±0,64 21,69±0,69 21,34±0,47
Presence of salts crystals in urocheras was regarded as a sign of initial urolithiasis stage (pre-lithiasis) which precedes a possible lithogenesis (stone formation) or accompanies this process that proves to be true by researches of K. Sachideu and coworkers. [1989] and others. J. Elliot and coworkers. [1989] consider that the number and the sizes of crystals of newly emitted urine reflect a tendency to a lithogenesis and consider crystalluria as a microurolithia-sis. By scientific researches it is proved that in this disease stage the preventive actions are most expedient and efficient, allowing preventing the subsequent processes of stone formation (Rakhmanov D. K., 1999, Tarasenko B. V 1991, Yuldashov F, 1998, Silva J. A. M. et al. 2002, Tiselius H. G., 2000). Further, in 20-40% of cases if not to carry out preventive maintenance, the crystalluria comes to the end with concrement formation (Baumann J. M. et al. 2003). Thus
the patients with pre-lithiasis and microurolithiasis require special attention, more steadfast, than the patient with ICD.
Pre-lithiasis diagnosed at detection of salts echo-patterns, according to renal ultrasonography and at presence of crystals at the microscopy of urine sediment.
In age groups of 15-19 and 20-29 years, pre-lithiasis level in comparison with age of 1-14 years increased, accordingly, in 4,3 and 5,8 times. Its highest level was observed with patients of40-49 years (10,40±0,94). At this age the highest indicators of urolithiasis case rate (2,74±0,50) were also observed. Growth of a case rate by urinary tract infections, was observed with age, reaching the peak by 70-79 years (26,11±3,51) (tab. 5). Also turns an attention on itself that with persons of over 70 years old the stones of urinary system organs practically were not observed.
Table 5. - Prevalence of separate urological diseases in the Aral Sea Area in various age groups (on 100 surveyed)
Age (years) Pre-lithiasis urolithiasis UTI
1-14 0,95±0,24 0,12±0,08 5,81±0,57
15-19 4,13±0,71 1,03±0,36 7,35±0,94
20-29 5,48±0,57 1,13±0,27 11,78±0,81
30-39 7,03±0,69 1,98±0,38 11,20±0,85
40-49 10,40±0,94 2,74±0,50 13,99±1,07
50-59 10,10±1,14 2,70±0,61 12,66±1,25
60-69 8,71±1,82 0,71±0,41 16,18±2,37
70-79 4,46±1,65 - 26,11±3,51
>80 9,09±6,13 - 22,73±8,93
Total 5,82±0,27 1,40±0,13 10,75±0,36
At including of outcomes of patients' inspection and treatment in the analysis group were guided by so-called criteria of «standard BPH patient» [Chatelian Ch. et al, 2001]. As the basis the clinical data testifying to presence at patients of benign prostate enlargement and bladder outlet obstuction caused by it has served for this purpose. Patients with bladder outlet obstruction, which was not connected with BPH, the general diseases influencing function
Table 6. - Prevalence of BPH signs in
of the bottom urinary tract, as well as earlier operated due to BPH have been excluded from research.
For studying prevalence of BPH, 489 men at the age of 50 years and older have been surveyed, which, depending on age, have been divided into groups — 50-59, 60-69, 70-79 and 80 years and older (Table 6).
the Aral Sea Area (for 100 surveyed)
Age (years) Number of men surveyed Prostate volume over 30 ml (%) Average urine flow rate < 10 ml/sec (%) Residual urine volume (%)
50-59 263 35,0±2,9 24,3±2,6 7,6±1,6
60-69 129 65,9±4,2 55,8±4,4 28,7±4,0
70-79 83 71,1±5,0 69,9±5,0 49,4±5,5
Over 80 14 85,7±9,4 92,9±6,9 92,9±6,9
Total 489 50,7±2,3 42,3±2,2 22,7±1,9
Volume of a prostate (V) is marked out as a basic sign of its benign hyperplasia. It is considered reliable and objective marker for BPH though its size not always correlates with degree of expression of symptoms of the bottom urinary tract and other signs of disease.
According to the standard data on standard value of volume of a prostate, in our researches we considered its enlarged if the gland volume exceeded 30,0 ml. Prevalence of this sign has made 50,7±2,3. With the years the prostate volume was enlarged that corresponds to the data specified in the world literature.
The average flow rate of urine was defined by division of volume of emitted urine for the period of urination. In order to obtain the authentic results, it is considered to be that in a bladder not less than 150.0 ml ofurine, initially, should contain. Results of the conducted research have shown that almost at half (42,3±2,2) the surveyed men rate of an urination has appeared below 10 ml/sec.
Presence of residual (post-voiding) urine (RU) yet does not allow diagnosing BPH with reliability, but testifies to its pathogenetic influence on the development mechanism of infravesical obstruction. Presence and volume of residual urine was defined right after the urination act. At 22.7±1.9 of the surveyed men the residual urine which volume was enlarged with the years has been detected.
Except the specified widespread urological diseases during epidemiological research, other urological pathology was observed: anomalies of development of genitourinary system, varicocele,
kidneys cysts, stressful urine incontinence, sterility, enuresis etc. As a whole, accompanying, most significant diseases have been observed at 914 inhabitants (12.0±0.4). All of them have received corresponding references for more profound inspection and treatment at the expert in a residence or in specialized clinics.
Conclusion
Definition of objective indicators values of prevalence of urological diseases becomes possible at revealing of the latent urological pathology. For the solution of this problem the purposeful epidemiological inspection of the big sample of the population of certain region would be more informative.
Essential value in carrying out of epidemiological inspection has attraction to its performance of a primary link of public health services (general practitioners), as the most approached and having possibility of implementation of early diagnostics of urological diseases The prime attention thus should be given to obligatory annual preventive medical inspection and ultrasonic research of organs of urinary ways, with the subsequent prophylactic medical examination of urological patients.
Application of specially developed universal questionnaire at epidemiological inspection of the population of Sub-Aral area has allowed defining the indicators of prevalence and improving early diagnostics of the most widespread urological diseases (UTI, urolithiasis, pre-lithiasis and BPH).
References:
1. Apolikhin O. I., Sivkov A. V., Beshliev D. A., Solntseva T. V., Komarova V. A. Analysis ofuro-nerological sickness rate in Russian federation as per the official statistics data.//Experimental and clinical urology. - 2010. - No. 1. - C. 4-11.
2. Arustamov D. L., Nurullaev R. B., Tarasenko B. V., Khudaybergenov U. A. Crystalluria epidemiology and prevention of initial litho-genesis in the environmentally unfavorable area of Uzbekistan//Uzbekistan Doctors Association Bulletin. - 2003. - No.3. - C. 36-38.
3. Arustamov D. L., Nurullaev R. B. Prevalence of the most significant urological diseases among the rural population of Uzbekistan//Urol-ogy - 2004. - No. 6. - C. 3-6.
4. Mello M. F., Marchini G. S., Camara C., Danilovic A., Levy R., Eluf-Neto J., Srougi M. and Mazzucchi E. "A large 15 - year database analysis on the influence of age, gender, race, obesity and income on hospitalization rates due to stone disease" Int Braz J Urol - 2016. -42 (6): 1150-1159.
5. Nurullaev R. B. Epidemiologic aspects, treatment and prevention of the most significant urological diseases. Author's abstract of dissertation ... of Doctor of Medicine. - T. - 2005. - P. 37.
6. Rakhmanov D. K. Epidemiology and initial prophylaxis of urolithiasis in Samarqand region. Author's abstract of dissertation ... of Doctor of Medicine: - Tashkent, - 1999. - P. 20.
7. Tarasenko B. V., Klyopov Yu.Yu., Maksudov S. A., Shabilalov D. A. Epidemiology of benign prostate hyperplasia and its social-economic significance.//Uzbekistan Doctors Association Bulletin. - 2002. - No. 2. - P. 82-95.
8. Tarasenko B. V. Pathogenetic justification of treatment of nephrolithic patient and metaphilaxis of lithogenesis relapses. Author's abstract of dissertation ... of Doctor ofMedicine: - M, - 1991. - P. 41.
9. Yuldashov F. Urolithiasis sickness rate in Uzbekistan and its reduction ways. Author's abstract of dissertation of Doctor of Medicine: -Tashkent, - 1998 - P. 37.
Epidemiology and clinical manifestations of benign prostatic hyperplasia in the Khorezm region
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-145-147
Khudaybergenov Ulugbek Ataullaevich, Tashkent Medical Academy, PhD in Medical Sciences, Faculty of Treatment E-mail: ulugbek0465@gmail.com Akilov Farkhad Ataullaevich, Republican Specialized Center of Urology, Doctor of Sciences in Medicine, Professor, Tashkent, Uzbekistan
E-mail: nepster1984@inbox.ru Makhmudov Azamjon Talatovich, Tashkent Medical Academy, Doctor of Sciences in Medicine, Faculty of Treatment E-mail: azamjon.makhmudov@gmail.com
Epidemiology and clinical manifestations of benign prostatic hyperplasia in the Khorezm region
Abstract: Epidemiologic studies are becoming relevant solution for efficient prophylactic tactics in urological disease treatment and prognosis. This paper is an attempt to highlight regional basis epidemiology of benign prostatic hyperplasia (BPH), particularly in Khorezm Region of Central Asia. This study focused preventive measurements of preventive therapy for the early detection of BPH and reduce the incidence of complications. Output of this study concludes that prevalence of symptoms of BPH increases progressively with age.
Keywords: Epidemiology, benign prostatic hyperplasia (BPH), urine flow data.
Introduction
Benign prostatic hyperplasia (BPH) — is one of the most common diseases in elderly men. In spite that during the last 20 years has been conducted many epidemiological and clinical researches all over the world, it is difficult to determine the prevalence of BPH.
Kim, Larson and Andriole determined age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause BPH development [9, 137-151]. About 8% of men aged 31-40 years have histological signs of BHP, to 6th decade this level will increase till 50% and reaches till 90% at 80 years [4, 864-875]. Several studies indicated that period prevalences, incidence rates, waiting time distributions and Lorenz curves were important factors to identify BHP prevalence. For instance, the results of a paper showed that 295,620 men had approximately 3 million dispensing events of the four Nordic countries. The period prevalence was markedly higher in Finland and Sweden than in Denmark and Norway. In 2009, period prevalences were 18.2/1000 males in Finland and 12.0/1000 males in Sweden compared to 6.7/1000 males in Norway and 4.9/1000 males in Denmark [8, 220-227]. An argument by Egan highlighted that cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS. However, these factors and their epidemiologic association with BPH/LUTS have not been thoroughly investigated [5, 289-297]. Research conducted in different Asian countries showed that age percentage relationship in men with severe and average symptoms of BHP were higher than in American [6, 40-46; 10, 391-395]. Prevalence varies from 18% in men aged 40 years to 56% in men aged 70 years [6, 40-46]. Research conducted in 30 cities of Iran, enveloped 8466 men aged 40 years and older. The overall morbidity rate was 23.8%. The incidence of BPH increases with age, from 1.2% among men 40-49 years to 36% over the age of 70 years [7, 78-81].
An epidemiological survey undertaken by R. B. Nurullayev in Khiva district of Khorezm region in Uzbekistan, showed that wide-
spread of BHP signs among population 50 years and older was: SLUT (IPSS, BS) — 100%, Qmax<15 ml/sec- 60.9%, residual urine-21.5%, V>30.0 ml-61.9% [2, 36-37].
An epidemiological survey of the population in risk group of certain regions of the Republic of Uzbekistan, showed that the prevalence rate of the disease in the age range 50-59 years was 22.7%, 60-69 years — 63.4%, 70-79 years — 49.7% and at the age of 80 years and older the proportion of patients with BPH reached 63.2%. This prevalence of BPH according to negotiability, in most regions of the country amounted to 7.6%, It was lower than that determined in the course of screening in 57.2 times [3, 7-17].
At the moment modern tactics of treatment of early stages of BPH helps huge amount of patients recover from symptoms of disease through drugs or mini-invasive interventions, cause of that modern diagnostics of disease becoming more actual [1, 33-42].
At the stage of health care reform in Uzbekistan more substantial and indisputable becomes the role of institutions such as rural medical centers (RMC) and territorial polyclinics, as well as professionals (general practitioners) primary care. In this aspect of the definition of actual values of primary health care in the recognition and treatment of urological diseases.
To assess the situation related to the incidence of urinary tract, requires modern information about it, as according to official statistical reports, as well as on the results of epidemiological studies conducted specifically among the population. Lack of completeness and detail of such information at the moment does not allow to present a complete picture of the status of the issue incidence of BPH. Another aspect of the problem is the involvement of primary care (general practice) in the control of urological disease, which is shown, again, as an example only individual disease entities.
The scientific value of the proposed research is to obtain data on the prevalence of BPH and associated diseases, based on population surveys focused on a special method of epidemiological survey. This allows to obtain reliable results of morbidity needed in public health activities, as well as for expert assessment of causal relationships that
