Bilharzial Vesicoureteric Reflux and Bladder Neck Stenosis: Fact or Fiction ?

Abstract

A group of 47 patients with histologically confirmed chronic urinary bilharziasis underwent micturating cystourethrography to look for vesicoureteric reflux (VUR) and bladder neck stenosis (BNS); 13 patients were found to have VUR of varying grades (8 unilateral and 5 bilateral). None had evidence of BNS. Urinary tract infection (UTI), loin pain, hydroureter and renal failure were compared in patients with and without VUR. Of the 13 patients with reflux, 3 had UTI, loin pain was present in 8, 11 had an ipsilateral hydroureter and 2 presented with renal failure. In the 34 patients without reflux, 8 had UTI, loin pain was present in 22, 30 had hydroureter and 3 presented with renal failure. It was concluded that the incidence of UTI, loin pain, hydroureter and renal deterioration associated with bilharzial VUR was not significantly different from that found in bilharzial patients without VUR. Thus the clinical significance and the need for surgical correction of isolated VUR in bilharziasis are questionable.

Diagnosis and management of complicated urogenital schistosomiasis: a systematic review of the literature

“…CT can be used to evaluate the presence of OU and other findings related to chronic schistosomiasis ▵ [ 20 ] Garba A 1999 Burkina Faso Transversal study Endemic area residents Ultrasound on 203 children with confirmed infection to detect the presence of OU in children in an hyperendemic area m/f Range: [7–15] The authors only report a prevalence of 2% of OU seen by US. Confirmation of potential role of US as a screening tool for OU △ [ 36 ] Ibrahim AI 1991 Saudi Arabia Transversal study Endemic area residents Micturating cystourethrogram in 47 patients to study the presence of OU in chronic Schistosomiasis m/f Mean [range]: 34.6 [18–68] Thirteen patients (27%) were found to have OU. Method is no longer of choice by current practices.…”

“…Whilst 12 studies have used US alone for the diagnosis of OU [ 12 , 19 – 29 ], others have used two methods to confirm the complication (intravenous urography in five case reports [ 30 – 34 ], anterior urography in one patient from a case series [ 33 ], CT scan in one case report [ 35 ]) or an invasive procedure (cystoscopy in one case report [ 35 ]). Very few studies compared the performances of radiological methods: only one study compared the performances of intravenous urography (considered the gold standard) and cystography, finding suboptimal performances of the latter (Sensitivity (Se) 26.8%; specificity (Sp) 66.7%; positive predictive value (PPV) 84.6%; negative predictive value (NPV) 11.8%) [ 36 ]. US proved superior to intravenous urography as one study found better performances (Se 89.5%; Sp 63.6%; PPV 81.0%; NPV 77.8%) and the ability to show hydronephrosis in patients whose kidneys were not visible via intravenous urography [ 37 ].…”

“…US proved superior to intravenous urography as one study found better performances (Se 89.5%; Sp 63.6%; PPV 81.0%; NPV 77.8%) and the ability to show hydronephrosis in patients whose kidneys were not visible via intravenous urography [ 37 ]. As said, intravenous urography has mainly been used as a gold standard in evaluating other diagnostic techniques [ 36 , 37 ] or to confirm ultrasonographic results [ 30 – 34 ]. One study assessed the sensitivity and specificity of cystography for the diagnosis of kidney failure in the setting of OU, but found no statistical difference in renal deterioration between patients with and without vesicoureteral reflux [ 36 ].…”

“…As said, intravenous urography has mainly been used as a gold standard in evaluating other diagnostic techniques [ 36 , 37 ] or to confirm ultrasonographic results [ 30 – 34 ]. One study assessed the sensitivity and specificity of cystography for the diagnosis of kidney failure in the setting of OU, but found no statistical difference in renal deterioration between patients with and without vesicoureteral reflux [ 36 ]. A case report [ 38 ] illustrated a case of S. haematobium -associated glomerulopathy, a phenomenon more frequently associated with S. mansoni [ 39 – 47 ].…”

Esquistosomiasis vesical, aportación de un caso y revisión de la literatura española

“…La cistografía evidencia la posible disminución de la capacidad vesical o aparición de defectos de replección que deberán ser evaluados mediante cistoscopia 1, 11,12,16 . La uretrografía retrógrada y miccional nos ayudan a diagnosticar posibles estenosis uretrales y esclerosis de cuello 35 Ciertos estudios defienden el papel de la ecografía en pacientes procedentes de áreas endémicas, teniendo sensibilidad similar a la urografía para la detección de lesiones vesicales, dilataciones ureterales, hidronefrosis y litiasis renales 36 .…”