Urinary-tract lesions of Schistosoma haematobium with detailed radiographic consideration of the ureter

Macroscopic and microscopic imaging modalities for diagnosis and monitoring of urogenital schistosomiasis

Urogenital schistosomiasis remains a major global challenge. Optimal management of this infection depends upon imaging-based assessment of sequelae. Although established imaging modalities such as ultrasonography, plain radiography, magnetic resonance imaging (MRI), narrow band imaging, and computerized tomography (CT) have been used to determine tissue involvement by urogenital schistosomiasis, newer refinements in associated technologies may lead to improvements in patient care. Moreover, application of investigational imaging methods such as confocal laser endomicroscopy and two-photon microscopy in animal models of urogenital schistosomiasis are likely to contribute to our understanding of this infection's pathogenesis. This review discusses prior use of imaging in patients with urogenital schistosomiasis and experimentally infected animals, the advantages and limitations of these modalities, the latest radiologic developments relevant to this infection, and a proposed future diagnostic standard of care for management of afflicted patients.

Bladder stones in a closed diverticulum caused by Schistosoma mansoni: A case report

BACKGROUND

Genitourinary (GU) schistosomiasis is a chronic infection caused by a parasitic trematode, with Schistosoma haematobium (S. haematobium) being the prevalent species. The disease has a variable prevalence around the world, with a greater burden on, but not limited to Africa, South America, Asia, and the Middle East.

CASE SUMMARY

We report the case of a 30-year-old man who presented with symptoms of bladder stones. During endoscopic cystolithalopaxy, we did not detect any stones in the bladder. Upon careful scanning of the urinary bladder trigone, sandy patches were detected. We performed endoscopic resection, which revealed a closed diverticulum with bladder stones. The diverticular wall was sent for histopathology and revealed features of chronic granulomatous inflammation with numerous embedded Schistosoma eggs, with some of the eggs having lateral spines. The patient was treated with praziquantel, and his symptoms completely resolved.

CONCLUSION

GU schistosomiasis is primarily caused by S. haematobium. However, Schistosoma mansoni mediated GU schistosomiasis is unusual, making this a quite interesting case.

Genitourinary schistosomiasis: life cycle and radiologic-pathologic findings

Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble-like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.

[Vesical schistosomiasis: an uncommon cause of bladder wall thickening]

Schistosomiasis is typically a tropical disease; however, given the large influx of immigrants to our country and the boom in tourism to exotic locations, schistosomiasis should be taken into account in the differential diagnosis of certain clinical entities. The flatworm Schistosoma haematobium can cause a large variety of lesions in the urinary tract. The most common sites of involvement are the bladder and the lower third of the ureters, where it can cause lesions ranging from lithiasis and ureteral stenosis to the formation of masses inside the bladder. Ultrasonography is the imaging technique of choice for evaluating these alterations in the bladder; in addition to being fast, noninvasive, and painless, it is very useful for monitoring the response to antihelmintic treatment. We believe that it is essential to know the alterations in the urinary tract caused by this trematode, as this infectious disease that can be cured with Praziquantel might be confused with tumor diseases, such as vesical masses.

99mTc DTPA diuretic renography in the evaluation of surgery in chronic schistosomal and non-schistosomal obstructive uropathy

The selection of patients with chronic obstructive uropathy for surgery is difficult because of problems in identifying true obstruction in a grossly dilated urinary tract. This is especially so in schistosomal (bilharzial) obstructive uropathy. A prospective study of 90 patients (68 with chronic schistosomal and 22 with non-bilharzial obstructive uropathy) was carried out. All patients underwent pre-operative and post-operative radionuclide 99mTc DTPA diuretic renography (RDR). The aims were to assess the value of RDR in the pre- and post-operative management of these patients and whether it could predict the outcome of surgery. Distinctive renogram patterns were identified in patients who required surgical management. These were found useful in monitoring the results and in predicting the outcome of surgery.

Striation of the renal pelvis and ureter in bilharziasis

The intravenous urograms of 80 patients aged 16 to 29 (mean 23) with urinary bilharziasis were reviewed to determine the frequency of striation of the renal pelvis and ureter. Another 345 patients aged 16 to 29 (mean 22) with various abdominal and urological symptoms, had intravenous urography during the same period and were used as a reference group. Striation of the upper urinary tract was demonstrated in 21% of the patients with urinary schistosomiasis but in only 3% of the reference group. Striation constitutes an early radiological change in this disease.

Bilharzial hydronephrosis: a clinicoradiological study

I have studied 68 patients with hydronephrosis. Except when complicated by infection, calculosis, cancer and severe strictures, function at excretory urography was relatively good even in advanced cases of hydronephrosis. In Zambia, Central Africa the intensity of infection and the disordered ureteral motility are the most important factors in the pathogenesis of bilharzial hydronephrosis. In other countries strictures, calculosis, ureteroceles, vesicoureteral reflux and bladder cancer apparently are more significant in these cases. Since reimplantation of the ureters usually fails because of fibrosis conservative treatment is advocated with periodic dilation of troublesome stricture(s). This is especially true since supra-infection is rare even after repeated surgical procedures. The importance of geographical variations of the disease and the relevance to clinical management are stressed.