HISTORICAL ASPECTS AND EPIDEMIOLOGY OF BENIGN PROSTATIC HYPERPLASIA

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 232 HISTORICAL ASPECTS AND EPIDEMIOLOGY OF BENIGN PROSTATIC HYPERPLASIA B.A. Ergashev1, T.A. Mahammadjonov2 Andijan State Medical Institute, Uzbekistan1,2 https://doi.org/10.5281/zenodo.17799871 Abstract. The authors note that benign prostatic hyperplasia (BPH) is one of the leading causes of lower urinary tract obstruction in elderly men. According to epidemiological studies, clinically significant manifestations of BPH are detected in 50–60% of men over 60 years old, and in 80–90% by the age of 80. These symptoms reduce the quality of life, contribute to chronic obstruction, urinary tract infections, and renal insufficiency. The authors conclude that in Uzbekistan there are objective problems such as late medical consultation, insufficient screening, and low awareness, which justify the need for regional clinical studies and the implementation of optimized surgical techniques. The relevance of this work is supported by the lack of systematic data on the comparative effectiveness of various surgical methods, especially minimally invasive ones, and by the identification of risk factors for complications. Keywords: benign prostatic hyperplasia (BPH); traditional transurethral resection of the prostate (TURP); holmium (HoLEP), thulium (ThuLEP), and Green Light lasers. Introduction Benign prostatic hyperplasia (BPH) is one of the leading causes of lower urinary tract obstruction in elderly men. Epidemiological studies indicate that clinically significant manifestations of BPH are present in 50–60% of men over 60 years of age and in 80–90% of men by the age of 80. These symptoms adversely affect quality of life and contribute to chronic obstruction, urinary tract infections, and renal insufficiency. Currently, patients with prostatic adenoma account for up to 30% of hospital admissions to urology departments. Many of these patients are of working age, highlighting the need for the urological community to select surgical treatments that are both effective and safe. Surgical intervention remains the most effective approach for alleviating obstructive symptoms. Traditional transurethral resection of the prostate (TURP) has demonstrated efficacy but is associated with frequent complications, including bleeding, water intoxication syndrome, urethral strictures, retrograde ejaculation, and urinary incontinence, particularly in elderly patients with cardiovascular comorbidities or a history of repeated surgeries. Modern techniques, such as holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), and Green Light laser therapy, reduce the incidence of complications, although limitations persist in cases of narrow urethra and large prostate volumes. Prostate diseases have been recognized since antiquity. The first anatomical descriptions of the prostate and its pathological changes were reported by Morgagni (1761) and Hunter (1775), who described an enlarged prostate and its impact on urination. In the 19th century, urologists such as Fergusson (1823) and Key established the relationship between age and the development of prostatic hyperplasia. By the late 19th and early 20th centuries, the first surgical treatments, including open prostatectomy, were introduced, although complication rates remained high. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 233 BPH is a polyetiological condition that arises from hyperplasia of the periurethral glandular zone of the prostate, resulting in lower urinary tract obstruction and impaired urination. Historically, the term “prostatic adenoma” was commonly used; however, most specialists now prefer “benign prostatic hyperplasia,” which more accurately reflects the pathogenetic and histological characteristics of the disease. Recent studies have also prompted revisions in the terminology used to describe various BPH-related conditions, reflecting the nonspecific nature of the symptoms and clinical manifestations observed in this disorder. Since the mid-20th century, advances in urology have enabled a transition to minimally invasive methods. The development of transurethral resection of the prostate (TURP) in the 1930s– 1940s represented a revolutionary step, significantly reducing surgical trauma and complications compared to open surgery. From the late 20th century, attention in urology has shifted to laser technologies such as HoLEP, ThuLEP, MiLEP, Green Light, and KTP lasers, which have improved functional outcomes and reduced the risk of bleeding. Benign prostatic hyperplasia (BPH) is one of the most common urological disorders among men over 50 years of age. The risk of prostatic adenoma increases with age. Before 40 years of age, only 8% of men experience urinary disturbances; by 50 years, this rises to 30%, by 60 years to 60%, and after 70 years, it exceeds 80%. International studies indicate that the prevalence of symptomatic BPH is approximately 50% among men aged 50–59 years and up to 90% in men over 80 years. According to a global review, in 2020, more than 210 million men worldwide had clinically significant BPH. The rising prevalence is associated not only with demographic aging but also with improved diagnostics, increased life expectancy, and the spread of risk factors such as obesity, metabolic syndrome, and sedentary lifestyle. In the CIS countries and Uzbekistan, precise statistical data are limited, although a steady increase is observed in the number of patients with lower urinary tract obstructive symptoms requiring surgical treatment. The prevalence of BPH generally corresponds to global figures, but data vary due to differences in healthcare access and diagnostic protocols. In Russia, according to the National Medical Research Center of Urology, clinically significant BPH is detected in 55– 60% of men over 60 years. Similar trends are observed in Kazakhstan, Kyrgyzstan, and Belarus, where 70–80% of men over 65 have the condition, yet only 40–50% receive surgical treatment. Regional studies show a pattern comparable to that in the CIS, with some distinctions. In Uzbekistan, Kazakhstan, and Tajikistan, local urological centers report BPH prevalence of 65– 75% among men over 60. At the same time, patients tend to seek medical attention later, due to limited awareness and restricted access to specialized care. Data from Uzbekistan are limited. According to official statistics from the Ministry of Health of the Republic of Uzbekistan, more than 15,000 cases of surgical BPH treatment were registered in 2022, with a significant proportion of patients presenting with pronounced symptoms and complications. Local studies by the Department of Urology at Andijan State Medical Institute indicate that up to 30% of men over 60 exhibit severe lower urinary tract symptoms requiring surgery. A particular feature of the Uzbek population is late diagnosis, low screening frequency, and insufficient awareness of modern minimally invasive treatment methods. The main risk factors include age, prostate volume, metabolic disorders (obesity, type 2 diabetes), chronic urinary tract infections, and previous surgical interventions. These factors underscore the clinical importance of developing optimized surgical strategies. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 234 Conclusion. Benign prostatic hyperplasia (BPH) represents a global urological challenge, with high prevalence among older male populations. The prevalence of the condition in the CIS countries and Central Asia is comparable to global figures; however, considerable variability exists in diagnosis and access to treatment. In Uzbekistan, objective challenges include late presentation, insufficient screening, and low public awareness, which underscore the need for regional clinical studies and the implementation of optimized surgical techniques. 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