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Studying of prevalence of the most significant urological diseases in the Aral Sea area.

Introduction

Data of the researches devoted to prevalence of illnesses of genitourinary sphere concern only separate nosological units or, as a last resort, their groups. Various studies on prevalence of urolithiasis, benign prostatic hyperplasia (BPH), urinary tract infections (UTI) have been carried out in various times in many countries (e.g., Apolikhin et al., 2010; Kozhabekov, 1998; Miller et al., 2009). Data coverage of the disease incidence, which is measured by appealability of patients to the medical aid, can be much wider. Objectivity of such data is relative, as appealability depends on many factors (availability of medical aid, its quality, sanitary culture of the population, its mentality, etc.). Receiving a comprehensive picture of true prevalence of diseases of organs of urinary ways and man's sexual sphere is not always possible.

Meanwhile, urological diseases, especially most significant of them-urolithiasis, UTI, BPH-are widespread; they reduce quality of life and cause disability in patients, require the big expenses for treatment and after treatment period (Arustamov and Nurullaev, 2004; Nurullaev, 2005; Tarasenko et al., 2002).

For a situation assessment related to urological incidence 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 studies conducted during recent years, including in Uzbekistan, have made the certain contribution to the resolution of the issue. However, it is necessary to notice that a study subject covered only separate aforementioned nosological units and their groups (Arustamov and Nurullaev, 2004).

Not studied aspect of the problem is defining possibilities and role of primary health care (general practitioner) in the control of urological diseases. 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 larger extent is connected with the activity of a primary level of public health services.

The study makes 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 was carried out among the population served by rural-medical centre (RMC) "Avaz Utar" of Yangiaryk district and RMC "Uygur" of Yangibazar district of Khorezm region. RMC "Kirkkiz" of Ellikkala district and RMC "Cheremushka" of Nukus district were chosen in the Republic of Karakalpakstan. The population of the specified sites was surveyed by a continuous method.

The Republic of Karakalpakstan and Khorezm region can be defined as the territories different in a complex of geographical (ecological) characteristics not only in the Republic of Uzbekistan, but also in the whole Central Asian region.

A representative sample of people of both sexes at the age from 1 year and older had been generated for the research. The population selected for epidemiological research represented a contingent of the countrymen, actually all life lived in the given area.

The incidence rate on appealability not always shows true level of diseases actual prevalence. It is known that a certain part of the population suffering from chronic diseases, for whatever reasons do not address for medical aid. In this connection to establish real prevalence of chronic diseases in the population according to appealability and current observation is often impossible. Based on this, for an assessment of true level of a incidence rate, in 2009-2011, employees of chair of urology of the Tashkent medical academy and the Republican Specialized Center of Urology (RSCU) organized an expedition. Together with general practitioners in the chosen sites complex medical examination of 7597 persons that made 85.4% of the number subject to survey had been conducted. The written approval of respondents on screening inspection and drug treatment had been received.

At distribution of the population structure on gender and age groups, for the analysis of separate urological diseases we used the international classification of diseases-ICD-10 (1993). As it is seen from the Table 1, the number of children, in total, made 1688 (22.2%), persons of youthful age-775 (10.2%). The overwhelming majority patients at the age from 20 till 69 years made 4955 (65.2%), over this age-179 (2.7%).

The specially developed universal questionnaire was applied to population inspection intended for defining symptoms inherent to urological diseases. The questionnaire includes 33 questions concerning symptoms of the bottom urinary tract, infections of urinary tract, incontinence of urine, pathology of man's sexual sphere. General practitioners of a primary health care 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 of urological 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.

Urine analyses were carried out by a quick test using of test-strips Urine-10 ("Cypress Diagnostics"). Microscopy of urine sediment was carried out when necessary.

BPH screening in the men over the age of 50 was carried out using the following methods: survey of respondents with the universal questionnaire, with filling of the international assessment questionnaire for the 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 to assess the presence and volume of a residual urine, scoping of a prostate and an average flow rate of urine.

All patients 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 and 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 [+ or -] 0.64 cases, in the Republic of Karakalpakstan-21.69 [+ or -] 0.69 cases for 100 surveyed (Table 2).

The analysis of level of a true incidence 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 urinary tract (10.75 [+ or -] 0.36) is most extended, it follows pre-lithiasis (5.82 [+ or -] 0.27), BPH (3.37 [+ or -] 0.21) and urolithiasis (1.40 [+ or -] 0.13). It is necessary to notice that in one case, comparison of level of prevalence of urological diseases in Khorezm region and the Republic of Karakalpakstan has not taped significant territorial differences of indicators (p>0.05) (Table 3).

The analysis of level of a true incidence rate of the population of Khorezm region and the Republic of 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 the Republic of Karakalpakstan-3.7 times that can be explained by anatomico-physiological features of genitourinary organs of women.

In the Republic of Karakalpakstan, there was some higher a prevalence of pre-lithiasis indicator with men-7.22 [+ or -] 0.69, with women it has made 5.47 [+ or -] 0.49.

It is necessary to notice that if at the age of 1-14 the prevalence of urological diseases on 100 surveyed has made 6.87 [+ or -] 0.62, then with persons of 80 years and older the value has made already 90.91 [+ or -] 6.13 (Table 4). Sharp increase in the incidence rate was noticed in age group of 60-69 years. If in persons of 50-59 years the incidence rate in comparison with age group of 1-14 years increased in 5.6 times, in the patients of 60-69 years old it increased more than 9 times. In Khorezm region indicators increased accordingly 5.2 and 8.8 times, and in Republic Karakalpakstan-6.3 and 9.9 times.

Presence of salts crystals in the urine sediment 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 Sachideu et al. (1989). Elliot and Rabinowitz (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 microurolithiasis. 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, 1999; Tarasenko, 1991; Yuldashov, 1998; Silva et al., 2002; Tiselius, 2000). Further, in 20-40% of cases if not to carry out preventive maintenance, the crystalluria comes to the end with concrement formation (Baumann et al., 2003). Thus, the patients with pre-lithiasis and microurolithiasis require special attention, more steadfas, than the patient with urolithiasis.

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, 4.3 and 5.8 times. Its highest level was observed with patients of 40-49 years (10.40 [+ or -] 0.94). At this age the highest indicators of urolithiasis incidence rate (2.74 [+ or -] 0.50) were also observed. Growth of incidence by urinary tract infections was observed with age increasing, reaching the peak by 70-79 years (26.11 [+ or -] 3.51) (Table 5). Also turns an attention the fact that in the persons of over 70 years old the stones of urinary system organs practically were not observed.

So-called criteria of "standard BPH patient" was used for inclusion of outcomes of patients' inspection and treatment to the analysis group (Chatelian et al, 2001). As the the clinical data testified the presence of benign prostate enlargement and bladder outlet obstruction it patients. Patients with bladder outlet obstruction, not connected with BPH, with the general diseases influencing function of the bottom urinary tract, as well as earlier operated due to BPH were excluded from research.

For studying prevalence of BPH, 489 men at the age of 50 years and older have been surveyed; they have been divided into age groups-50-59, 60-69, 70-79 and 80 years and older (Table 6).

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 value data on the volume of a prostate, in our researches we considered it enlarged if the gland volume exceeded 30.0 ml. Prevalence of this sign has made 50.7 [+ or -] 2.3. With the years the prostate volume increases 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 that not less than 150.0 ml of urine initially should contain in a bladder. Results of the conducted research have shown that almost in half (42.3 [+ or -] 2.2) of the surveyed men the rate of 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. In 22.7 [+ or -] 1.9 of the surveyed men the residual urine has been detected, its volume increases with the age increase.

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 in 914 inhabitants (12.0[+ or -]0.4). All of them received corresponding references for more profound inspection and treatment at the expert in a residence or in specialized clinics.

Conclusion

Determining the objective indicators values of prevalence of urological diseases becomes possible with 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 public health care services (general practitioners), as the most approached and having capacity 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 in the epidemiological inspection of the population of the Aral Sea Area has allowed defining the indicators of prevalence and improving early diagnostics of the most widespread urological diseases (UTI, urolithiasis, prelithiasis and BPH).

References

Apolikhin, O., Sivkov, A., Beshliev, D., Solntseva, T., Komarova, V., 2010. "Analysis of uro-nerological sickness rate in Russian federation as per the official statistics data," J Experimental and clinical urology [Eksperimentalnaya i Klinitcheskaya Urologiya], in Russian, No.1, pp.4-11

Arustamov, D., Nurullaev, R., 2004. "Prevalence of the most significant urological diseases among the rural population of Uzbekistan," Urology [Urologiya], in Russian, No.6, pp.3-6

Baumann, J., Affolter B., Caprez U. et al., 2003. "Calcium oxalate aggregation in whole urine, new aspects of calcium stone formation and metaphylaxis," Eur.Urol, Vol.43(4), pp.421-25

Chatelian, Ch., Denis, L., Foo, J., Khoury, S., Connel, J., Abrams, P., Barry, M., Bartsch, G., Boyle, P., Brawer, M., Corriere, J., Debruyne, F., Dreikorn, K., Jardin, A., Lee, Ch., Nastund, M., Nordling, J., Resnick, M., Roehrborn, C. and the Members of the Committees, 2001. "Evaluation and Treatment of Lower Urinary Tract Symptoms (LUTS) in Older Men," 5th International Consultation on BPH Recommendations of the International Scientific Commitee. Proc.-Paris: Health Publication, pp.519-34.

Elliot, J., Rabinowitz, I., 1989. International symposium on urolithiasis, 6th Proceedings, New York

Kozhabekov, B., 1998. Complex study of epidemiologic and etiologic aspects, early diagnostics, and medical aids and metaphylaxis assessment of urolithiasis [Kompleksnoje izutchenie epidemiologitcheskih i etiologitcheskih aspektov, ranney diagnostiki, ocenki letchebnih posobiy i metafilaktiki motchekamennoy bolezni], in Russian, Synopsis of doctoral dissertation, Almaty, Kazakhstan

Miller, D., Saigal, C., Litwin, M., 2009. "The demographic burden of urologic diseases in America," Urol. Clin. North Am., Vol.36, No.1, pp.11-27

Nurullaev, R., 2005. Epidemiologic aspects, treatment and prevention of the most significant urological diseases [Epidemiologitcheskie aspekty, letcheniya i profilaktika naibolee urologitcheskih zabolevaniy], in Russian, Synopsis of doctoral dissertation, Tashkent, Uzbekistan

Rakhmanov, D., 1999. Epidemiology and initial prophylaxis of urolithiasis in Samarqand region [Epidjemiologiya i pervitchnaya profilaktika urolitiaza v Samarkandskom regione], in Russian, Synopsis of doctoral dissertation, Tashkent, Uzbekistan

Sachideu, K., Sindhu, S., Vathsaala, R. et al., 1989. International symposium on urolithiasis, 6th Proceedings, New York , pp.35-36

Silva, J., Guerra, P., Raggi P., 2002. "Stone recurrence rate and metaphylaxis in patients underwent extracorporeal shock wave lithotripsy," 10th Eur. Symp. on Urolithiasis (Istanbul, 11-14 June), pp.279-281

Tarasenko, B., Klyopov, Yu., Maksudov, S., Shabilalov, D., 2002. "Epidemiology of benign prostate hyperplasia and its social-economic significance," Uzbekistan Doctors Association Bulletin [Bulleten Associacii Vrachey Uzbekistana], in Russian, No.2, pp.82-95

Tarasenko, B., 1991. Pathogenetic justification of treatment of nephrolithic patient and metaphilaxis of lithogenesis relapses [Patogenetitcheskoe obosnovanie differenzirovannogo letcheniya bolnih nefrolitiazom i metafilaktiki recidivov kamneobrazovaniya], in Russian, Synopsis of doctoral dissertation, Tashkent, Uzbekistan

Tiselius, H., 2000 "Stone incidence and prevention," Braz J Urol. Vol.26(5), pp.452-62

Yuldashov, F., 1998. Urolithiasis sickness rate in Uzbekistan and its reduction ways [Zabolevaemost motchekamennoy boleznyu v Uzbjekistanje i puti eye snizheniya], in Russian, Synopsis of doctoral dissertation, Tashkent, Uzbekistan

Farhod Akilov, Ulugbek Khudaybergenov, Telman Huraliev, Maksud Rahimov

Republican Specialized Center

of Urology, Uzbekistan
Table 1. Distribution of the surveyed population on gender and age

Gender             Male          Femal           Total

Age group, yr   n      %      n        %      n       %
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
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

Table 2. Prevalence of separate urological diseases
in the Aral Sea Area (on 100 surveyed)

                                                 As a whole on
               Khorezm region   Karakalpakstan      region

Prelithiasis      5.51[+           6.16[+           5.82[+
                 or -]0.36        or -]0.40        or -]0.27

Urolithiasis      1.65[+           1.11[+           1.40[+
                 or -]0.20        or -]0.17        or -]0.13

UTI               10.85[+          10.65[+         10.75[+
                 or -]0.49        or -]0.51        or -]0.36

bph               3.01[+           3.77[+           3.37[+
                 or -]0.27        or -]0.32        or -]0.21

Total             21.02[+          21.69[+         21.34[+
                  or -]0.64        or -]0.69        or -]0.47

Table 3. Prevalence of separate urological diseases
in the Aral Sea Area depending on gender (on 100 surveyed)

                                    Khorezm region

                     Male               Female         p value

Prelithiasis   5.37[+ or -]0.57    5.61[+ or -]0.47    >0.05

Urolithiasis   1.87[+ or -]0.34    1.51[+ or -]0.25    >0.05

UTI            5.04[+ or -]0.56    14.53[+ or -]0.71   <0.001

bph            7.63[+ or -]0.67

Total          20.04[+ or -]1.02   21.64[+ or -]0.83   >0.05

                                    Karakalpakstan

                     Male               Female         p value

Prelithiasis   7.22[+ or -]0.69    5.47[+ or -]0.49    <0,05

Urolithiasis   1.27[+ or -]0.30    1.00[+ or -]0.21    >0,05

UTI            4.03[+ or -]0.52    14.91[+ or -]0.76   <0,001

bph            9.13[+ or -]0.77

Total          22.15[+ or -]1.10   21.39[+ or -]0.88   >0,05

                                     As a whole on
                                        region

                     Male               Female         p value

Prelithiasis   6.25[+ or -]0.44    5.54[+ or -]0.34    >0.05

Urolithiasis   1.59[+ or -]0.23    1.27[+ or -]0.16    >0.05

UTI            4.56[+ or -]0.38    14.71[+ or -]0.52   <0.001

bph            8.34[+ or -]0.51

Total          21.05[+ or -]0.75   21.52[+ or -]0.60   >0.05

Table 4. Prevalence of urological diseases
in the Aral Sea Area depending on age of the surveyed
(on 100 surveyed)

          Khorezm                                   As a whole
Age, yr   region               Karakalpakstan       on region

1-14      7.52[+ or -]0.85     6.00[+ or -]0.89     6.87[+ or -]0.62

15-19     12.50[+ or -]1.58    12.54[+ or -]1.81    12.52[+ or -]1.19

20-29     19.73[+ or -]1.40    17.01[+ or -]1.35    18.40[+ or -]0.97

30-39     20.11[+ or -]1.52    20.30[+ or -]1.55    20.20[+ or -]1.09

40-49     25.69[+ or -]1.88    28.63[+ or -]1.99    27.13[+ or -]1.37

50-59     39.29[+ or -]2.66    37.87[+ or -]2.53    38.55[+ or -]1.84

60-69     66.02[+ or -]4.67    59.42[+ or -]4.18    62.24[+ or -]3.12

70-79     76.83[+ or -]4.66    65.33[+ or -]5.50    71.34[+ or -]3.61

>80       81.82[+ or -]11.63   100.00[+ or -]0.00   90.91[+ or -]6.13

Total     21.02[+ or -]0.64    21.69[+ or -]0.69    21.34[+ or -]0.47

Table 5. Prevalence of separate urological diseases in the Aral
Sea Area in various age groups (on 100 surveyed)

Age, yr   Prelithiasis        Urolithiasis       UTI

1-14      0.95[+ or -]0.24    0.12[+ or -]0.08   5.81[+ or -]0.57

15-19     4.13[+ or -]0.71    1.03[+ or -]0.36   7.35[+ or -]0.94

20-29     5.48[+ or -]0.57    1.13[+ or -]0.27   11.78[+ or -]0.81

30-39     7.03[+ or -]0.69    1.98[+ or -]0.38   11.20[+ or -]0.85

40-49     10.40[+ or -]0.94   2.74[+ or -]0.50   13.99[+ or -]1.07

50-59     10.10[+ or -]1.14   2.70[+ or -]0.61   12.66[+ or -]1.25

60-69     8.71[+ or -]1.82    0.71[+ or -]0.41   16.18[+ or -]2.37

70-79     4.46[+ or -]1.65    -                  26.11[+ or -]3.51

>80       9.09[+ or -]6.13    -                  22.73[+ or -]8.93

Total     5.82[+ or -]0.27    1.40[+ or -]0.13   10.75[+ or -]0.36

Table 6. Prevalence of BPH signs
in the Aral Sea Area (for 100 surveyed)

                                      Average
                Prostate volume     urine flow      Residual urine
                   over 30ml           rate             volume
Age, yr   n           (%)         < 10ml/sec (%)          (%)

50-59     263   35.0[+ or -]2.9   24.3[+ or -]2.6   7.6[+ or -]1.6

60-69     129   65.9[+ or -]4.2   55.8[+ or -]4.4   28.7[+ or -]4.0

70-79     83    71.1[+ or -]5.0   69.9[+ or -]5.0   49.4[+ or -]5.5

Over 80   14    85.7[+ or -]9.4   92.9[+ or -]6.9   92.9[+ or -]6.9

Total     489   50.7[+ or -]2.3   42.3[+ or -]2.2   22.7[+ or -]1.9
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Author:Akilov, Farhod; Khudaybergenov, Ulugbek; Huraliev, Telman; Rahimov, Maksud
Publication:Medical and Health Science Journal
Article Type:Report
Geographic Code:9UZBE
Date:Apr 1, 2012
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