The study aimed to evaluate the clinical effectiveness of various treatment approaches for encrusted cystitis (EC) and to develop practical recommendations for choosing management tactics depending on the extent of bladder mucosal involvement. The underlying hypothesis was that a comprehensive, differentiated approach—combining surgical sanitation with targeted urinary diversion based on the area of encrustation—would achieve stable remission even in previously "incurable" cases involving total mucosal damage and frequent recurrences.

A retrospective study was conducted at the Republican Specialized Scientific and Practical Medical Center of Urology (Uzbekistan) between 2006 and 2024. The study included 59 patients aged 34–78 years with a confirmed diagnosis of encrusted cystitis. The diagnostic protocol included a clinical examination, medical history (revealing bladder catheterization and surgical interventions on the lower urinary tract), general urinalysis, and urine culture. Urine pH monitoring showed that 85% of patients had an alkaline environment (pH 7–9). Further evaluation involved ultrasound, cystoscopy, and computed tomography to visualize the extent of calcification. The microbiological spectrum primarily consisted of urease-producing microorganisms, such as Proteus spp., Klebsiella spp., and Pseudomonas spp.. Treatment strategies integrated transurethral resection (TUR) of affected areas, targeted antibacterial therapy, urine acidification, bladder instillations, and urinary diversion (percutaneous cystostomy or bilateral nephrostomy) for severe cases.

Complete recovery after the initial surgical intervention and basic therapy was observed in 36 patients. Recurrence occurred in 23 patients. To achieve stable remission in these recurrent cases, 18 patients required percutaneous cystostomy combined with basic therapy. Five patients with the most extensive, total mucosal involvement required bilateral percutaneous nephrostomies and repeated surgical resections. The average drainage period was 37 days. It was established that treatment effectiveness was directly associated with the lesion area: limited processes (up to 10 cm²) were successfully managed with TUR and basic therapy; lesions between 10–40 cm² required combined resection and cystostomy; in cases with lesions measuring 10–40 cm², encrustation localized in the bladder neck and a history of frequent recurrences served as decisive factors for performing percutaneous cystostomy, and extensive processes (>40 cm²) necessitated a multistage approach, including bilateral nephrostomy to ensure clinical success.

The findings indicate that surgical removal (TUR) alone fails because it does not eliminate the alkaline environment and bacterial biofilms that drive salt precipitation. The core principle of successful treatment is providing "functional rest". For the 10–40 cm2 category involving the bladder neck, cystostomy is vital to mitigate the continuous mechanical trauma and chemical irritation caused by infected urine during the voiding cycle. This anatomical zone is particularly vulnerable, as mechanical stress prevents stable epithelialization and residual urine promotes bacterial persistence. In the most severe cases (>40 cm2), complete urine diversion via bilateral nephrostomy is required to isolate the healing mucosa from the infected alkaline environment entirely. This allows the organ to regenerate over several months, effectively breaking the cycle of chronic inflammation and biomineralization.

Effective management of encrusted cystitis requires a multimodal approach involving surgical, pharmacological, and metabolic control. The integration of urinary diversion techniques into the treatment algorithm for extensive or recurrent forms of the disease significantly improves clinical outcomes. This rational strategy allows for complete recovery and the avoidance of more radical, disabling interventions in patients with this complex urological pathology.