The dissertation abstract by Safojon Samukjanovich Kasimov, submitted for the degree of Doctor of Philosophy (PhD) in Medical Sciences, examines endoscopic treatment of obstruction of the prostatic urethra and bladder neck occurring after surgical interventions for benign prostatic hyperplasia.
The relevance of this research is associated with the fact that this complication may cause narrowing or complete obstruction of the urinary tract, require repeated surgical interventions, and significantly reduce patients' quality of life. Improving modern endoscopic treatment techniques is an important approach to addressing this clinical problem.
The primary aim of the study was to improve treatment outcomes in patients with postoperative obstruction of the prostatic urethra and bladder neck through the use of endoscopic recanalization under fluoroscopic guidance.
The study included 45 patients with obstruction of the posterior urethra and bladder neck following transvesical adenomectomy. The patients were examined and treated at the Republican Specialized Scientific and Practical Medical Center of Urology between 2010 and 2022.
The study developed an endoscopic recanalization technique performed under fluoroscopic guidance, followed by electroresection of the obliterated tissue. This approach is aimed at restoring urinary tract patency and improving patients' quality of life.
The study also established the main criteria for performing endoscopic recanalization under radiological guidance:
The study found that the presence of mixed urinary tract infections and diabetes mellitus negatively affects treatment outcomes.
According to the study conclusions, the effectiveness of the technique involving repeat recanalization of the urethra and bladder neck followed by transurethral resection (TUR) of sclerotic tissue was 73% after the first intervention and 27% after the second intervention.
Risk factors for unsatisfactory treatment outcomes included bladder drainage lasting more than 5 weeks and an obstruction length exceeding 30 mm. Mixed urinary tract infections and diabetes mellitus were also identified as factors that reduce treatment effectiveness.
According to the Clavien–Dindo classification, the overall rate of postoperative complications was 44.3%. Grade I and II complications occurred in 20% of cases.
The endoscopic recanalization technique developed through this research has been implemented in the clinical practice of the Republican Specialized Scientific and Practical Medical Center of Urology and its branches in the Fergana and Khorezm regions.
The social significance of the method lies in its potential to free patients from lifelong cystostomy drainage and improve their quality of life. According to the economic calculations presented in the dissertation, patients requiring monthly drainage replacement incur annual expenses of 2,871,600 Uzbek soums.
Researcher: Safojon Samukjanovich Kasimov.
Scientific Supervisor: Furqat Raufovich Nasirov, Doctor of Medical Sciences.
Official Opponents: Bekhzod Alisherovich Ayubov and Mirzamahmud Alisherovich Shadmanov.
Leading Institution: Fergana Medical Institute of Public Health.
Specialty: 14.00.31 — Urology.
Institution where the dissertation was conducted: Tashkent State Medical University.