Some urological complications of bilharziasis in Iraq

In situ extracorporeal shock wave lithotripsy for primary ureteric calculi

OBJECTIVE

To determine the efficacy of the Lithostar lithotriptor for the in situ treatment of primary ureteric stones.

METHODS

We reviewed, retrospectively, our experience with 283 patients with primary ureteric stones treated with extracorporeal shock wave lithotripsy (ESWL) using the Lithostar lithotriptor. No attempts were made to manipulate the stones. The majority of the patients were treated using only intravenous analgesia. Auxiliary measures were used in 84 patients (29.6%). There were 112 patients (39.6%) with upper, 53 (18.7%) with middle, and 118 (41.7%) with lower ureteric stones.

RESULTS

A single ESWL session was needed for 200 patients (70.6%), two for 49 patients (17.3%), and more than two sessions for 34 patients (12%). Of the 248 patients who had adequate follow-up, 220 (88.7%) were stone free, 14 (5.65%) had some residual stone, while 14 (5.65%) patients failed to respond to the treatment. Patients' gender and body weight influenced the treatment and the clearance rate numerically without any statistical significance. The stone site was the most significant factor influencing the final result. Stones larger than 10 mm and the presence of hydronephrosis adversely affected the treatment.

CONCLUSIONS

In situ ESWL of ureteral stones with the Lithostar device is a convenient and efficient method of treating calculi within the whole length of the ureter without the need for any manipulation.

Multiple urolithiasis in bilharziasis patients

A total of 780 patients were operated on for lithiasis. Among them 97 presented multiple urolithiasis which was often associated with Schistosoma infection. Bilharziasis, in accord with theoretical considerations, plays a part in the formation of calculi, especially in that of multiple urolithiasis.

Urolithiasis in Kuwait

This is a retrospective study of 142 stone-formers admitted during 1981 to a general surgical unit of a district hospital. The majority were adult non-Kuwaiti males. Contrary to expectations it was the manual workers from lower economical social strata who were commonly afflicted. The possible reasons for this are discussed. There were no specific biochemical defects in the patients' sera but of 22 patients whose 24-hour urines were examined, half had some abnormality. The majority of IVPs showed some anatomical abnormalities. Calculi were passed spontaneously in nearly half of the patients.

Ultrasonographical aspects of urinary schistosomiasis: assessment of morphological lesions in the upper and lower urinary tract

Ultrasonographic evaluation of 213 patients with urinary schistosomiasis in different age groups was performed in an endemic area of the Democratic Republic of Congo. The results were compared with 94 age matched controls without urinary schistosomiasis. In patients the bladder showed thickening of the wall, polypoid lesions of the mucosa and bladder wall, calcifications and urinary retention. Urinary tract obstruction, predominantly unilateral, was demonstrated. The lesions increased in severity with the intensity of infection, parallel to an increase in ova excretion. Children aged between 8 and 19 years were most severely affected. Pathological lesions of the upper urinary tract were rare in patients over 25 years of age. The combination of morphological abnormalities was interpreted as being specific for urinary schistosomiasis as they did not occur in the control group. It is suggested that real time ultrasonography may be used to identify morphological lesions in urinary schistosomiasis.

Urinary calculus in Zambia: its incidence and relationship to Schistosoma haematobium infection and vesicovaginal fistula

Radiological, cystoscopic and histological observations were made on 41 cases of urinary stones in a hospital in Zambia. The results of biochemical analysis of 31 of these stones are presented. The possible role of Schistosoma haematobium in the causation of urinary stones has been analysed; associated schistosomiasis was diagnosed in 17 cases (41.4%). It is concluded that there is no significant causal association between the two disorders and urolithiasis is an uncommon disease in Zambians.

The role of schistosomiasis in urolithiasis

Both urinary schistosomiasis and urolithiasis are common in Saudi Arabia and other countries and an aetiological relationship between them has been suggested. One hundred and fifty Saudi Arabian patients suffering from urinary schistosomiasis were compared with a similar number of patients suffering from urolithiasis and with a control group. The evidence suggests that in Saudi Arabia, schistosomiasis plays a very limited role in urinary tract stone formation.

The relationship between urinary bilharziasis and urolithiasis in the Sudan

Nine hundred and ninety-seven Sudanese patients presenting to a urological unit in Khartoum were divided into a group consisting of 144 patients with a history or evidence of urinary bilharziasis and a second group of 853 patients with no history or evidence of this disease. Thirty-one per cent of the patients with bilharziasis and 32% of those without were found to have urinary calculi. In the bilharzial group there were recurrent stones in 7% compared with 12.4% in the non-bilharzial group. In the bilharzial group the stones were renal in 63.6%, ureteric in 27.3% and vesical in 9.1%, while in the non-bilharzial group 57% were renal, 30% ureteric and 13% vesical. Comparison of the incidence, rate of recurrence and site of stones in both groups suggests that urinary bilharziasis does not contribute to the high incidence of urolithiasis in the Sudan.