FILARIAL CYSTITIS WITH URETERAL OBSTRUCTION

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Filariasis is a common parasitic infection in the tropics. The epididymis, scrotum, penile skin and rarely the kidney are the sites of involvement in the genitourinary tract. To our knowledge we report the first case of filarial cystitis with ureteral obstruction with an excellent response to medical therapy. CASE REPORT A 58-year-old man presented with frequent dysuria and left loin pain 4 months in duration with 1 episode of hematuna. He was from northeastern India, which is endemic for filariasis. Physical examination was noncontributory. Urine was sterile and showed numerous red cells on microscopy. Biochemical parameters and renal function were normal. An excretory urogram showed delayed excretion on the left side and a small capacity bladder (fig. 1, A). Ultrasound demonstrated left hydronephrosis. The right kidney was normal. At cystoscopy the mucosa was red and edematous. The left ureteral orifice could not be located. Bladder capacity was 250 ml. Multiple bladder mucosal biopsies were taken. To salvage renal function ultrasound guided left percutaneous nephrostomy was performed. The nephrostogram revealed a 3 cm. narrowing at the lower end of the ureter (fig. 1, B). Bladder biopsy showed evidence of bladder mucosa inflammation with Wuchereria bancrofti microfilaria in the wall (fig. 2). Peripheral blood smear was negative for microfilaria and urine was negative for eosinophils. The patient was started on diethylcarbamazine and antiinflammatory drugs. Symptomatically, there was marked improvement. A nephrostogram 8 weeks later showed free drainage of contrast material into the bladder. Cystoscopy demonstrated improvement in the appearance of the bladder