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Abstract
OBJECTIVE: To review our experience with reconstructions of ureteral complications of Schistosoma haematobium, in a centre situated in an endemic zone. PATIENTS: Fifty one patients operated for bilharzial complications of the ureters. METHODS: A retrospective analysis of patients operated upon, at the Coast Province General Hospital, Mombasa, Kenya between 1996 and 2008. All patients had obstructive ureteral complications. Data abstracted included demographics, level and nature of complication, surgical options utilized and follow-up. RESULTS: Endoscopic visual internal ureterotomy (VIU) was performed in 21 (41%) patients, resection and ureteroneocystostomy in 27 (49% of 55 procedures done), resection and ureteroureterostomy in one, nephrectomy in two and ileal replacements in two. Nephrostomy was performed in two patients who presented with anuria. Two patients restenosed after VIU and were offered resection and ureteroneocystostomy. One patient restenosed after ureteroneocystostomy and underwent a revision with psoas hitch. One patient with nephrostomy had bilateral ureteric replacement with ileum to skin. The two patients with anuria who had nephrostomy done eventually died of progressive renal failure. CONCLUSION: Schistosoma haematobium is associated with severe complications of the upper urinary tracts. Once established these complications are amenable to surgical correction, by both open and endoscopic techniques as long as renal function is not irretrievably impaired.
Highlights
The trematode Schistosoma haematobium is transmitted to man by contact with contaminated water (Figure 1).The adult worms reside in the vesical and pelvic venous plexuses where the female lays eggs.The urinary bladder, distal ureters and seminal vesicles are most commonly affected, due to their rich venous supply [1].The pathological effects of Schistosoma haematobium infestation in man are mainly the result of an intense host reaction to the eggs which secrete a histiolytic antigen that evokes a cell mediated immune response, culminating in formation of granulomatous lesions [1]
Endoscopic visual internal ureterotomy (VIU) was performed in 21 (41%) patients, resection and ureteroneocystostomy in 27 (49% of 55 procedures done), resection and ureteroureterostomy in one, nephrectomy in two and ileal replacements in two
Two patients restenosed after VIU and were offered resection and ureteroneocystostomy
Summary
The trematode Schistosoma haematobium is transmitted to man by contact with contaminated water (Figure 1).The adult worms reside in the vesical and pelvic venous plexuses where the female lays eggs.The urinary bladder, distal ureters and seminal vesicles are most commonly affected, due to their rich venous supply [1].The pathological effects of Schistosoma haematobium infestation in man are mainly the result of an intense host reaction to the eggs which secrete a histiolytic antigen that evokes a cell mediated immune response, culminating in formation of granulomatous lesions [1]. The trematode Schistosoma haematobium is transmitted to man by contact with contaminated water (Figure 1). The adult worms reside in the vesical and pelvic venous plexuses where the female lays eggs. The urinary bladder, distal ureters and seminal vesicles are most commonly affected, due to their rich venous supply [1]. The pathological effects of Schistosoma haematobium infestation in man are mainly the result of an intense host reaction to the eggs which secrete a histiolytic antigen that evokes a cell mediated immune response, culminating in formation of granulomatous lesions [1]. Eggs may be found in all layers of the distal ureters; with resultant mural fibrosis, leading to loss of muscle and development of periureteral adhesions. Urinary stasis and secondary bacterial infection predispose to calculi formation [1]
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