Benign urological manifestations of vesical schistosomiasis infestation in Abuja: case series

Abstract

Urinary schistosomiasis is the most frequently encountered bilhaziasis infestation in Africa with wide range of clinical manifestation. We present three cases of urinary schistosomiasis with different manifestations. The aim is to emphasize the importance of high index of suspicion in the absence of the classical features of urinary schistosomiasis.

Case One: He presented with left sided lower abdominal pain, recurrent hematuria and storage lower urinary tract symptoms. Urologic scan showed a hyperechoic mass measuring 10.2mm at the left ureterovesical junction and casting an acoustic shadow posteriorly. Intraoperative findings were that of a stenosed left distal ureter about 5mm from the ureteric orifice. We performed a left stented refluxing ureteroneocystostomy with excision of the stenosed ureter. Histologic section was suggestive of ureteric schistosomiasis.

Case Two: She presented with predominantly storage lower urinary tract symptoms and lower abdominal pain. Urologic scan showed thick walled urinary bladder with a central mass. Cystoscopy revealed a small capacity bladder with a polypoid mass arising from the dome of the bladder which was excised endoscoically and sent for histological analysis. The histology report was suggestive of schistosomiasis.

Case Three: She presented with storage lower urinary tract symptoms and painful terminal hematuria. Abdominal sonography and CT showed gross bilateral hydroureteronephrosis down to the vesicoureteric junction. Cystoscopy showed small capacity bladder (<60ml) with sandy patches at the trigone. She had augmentation cystoplasty and ureteric re-implantation.

Conclusion: A strategy for public enlightment, screening and early detection of schistosoma infestation of the urinary tract will provide a better assessment of this endemic parasitic infection with rising global public health concern.

Keywords: Bladder, Cystoscopy, Histology, Schistosoma haematobium, Schistosomiasis, Terminal Hematuria