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Surgery for ureteral complications of bilharziasis
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.
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.
