Cystoscopic removal of leeches in the lower urinary tract: our experience.

INTRODUCTION: The purpose of this study is to describe the experience of managing leech infestation in lower urinary tract from a tropical country. MATERIALS AND METHODS: Medical records (January 2002 to December 2010) of children with history of leech infestation in the urinary system, admitted in the Department of Pediatric Surgery, Chittagong Medical College & Hospital, Chittagong, Bangladesh were reviewed. All patients underwent saline irrigation through urethral catheter. When saline irrigation failed, cystoscopic examination was done with removal of leeches by flexible graspers. Follow-up was done 2 weeks later. RESULT: The study included 117 patients. Age ranged from 4 to 12 years. Male and female ratio was 3.7:1. All patients had per urethral bleeding. 51 (43.6%) patients had suprapubic pain. All children underwent saline irrigation through urethral catheter. Spontaneous expulsion occurred after saline irrigation in 57 (48.7%) patients. The expelled leeches were alive in 11 cases; dead in 46 patients. Cystoscopic removal of leeches was done in 60 patients (51.3%). In the cystoscopic group, 54 of the removed leeches were dead and 6 were alive. CONCLUSION: Cystoscopic removal can be a useful technique for the removal of leeches from the urinary tract when saline irrigation fails.

An unusual case of urethral hiriduniasis.

Bleeding as the result of a leech in the male urethra is very rare. We describe a 13-year-old boy who had a leech in his urethra. In the emergency department he persistently squeezed his penis in an attempt to prevent the leech from going deeper into his urethra. Manual removal by forcep failed and cystoscopic removal was recommended. Penile block with lidocaine 1% relieved the pain and enabled him to squeeze his penis harder until the leech was pushed out making forcep removal easier. Post-removal he had hematuria and penile pain for 2 days. A description of his presentation and management, along with a review of the literature is presented.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. II. Obstructive uropathy.

In a series of 32 unselected consecutive autopsies of Egyptian male adults, we found a significant prevalence of schistosomal obstructive uropathy (SOU) and of precursor lesions of stenosis, fibrosis and induration of the ureters (62.5%). Lower urinary tracts with obstructive uropathy had a significantly higher total egg burden (TEB) than did lower urinary tracts with any other type of gross lesion (i.e., benign prostatic hypertrophy, other urethral outlet obstruction, or SOU precursor lesions). In turn, lower urinary tracts with any type of gross change had higher egg burdens than did tracts which appeared grossly normal. Lower urinary tracts with any type of gross lesion had significantly larger seminal vesicles than did tracts which were grossly normal. Moreover, relative weight of seminal vesicles could be correlated with the S. haematobium egg burdens in the seminal vesicles. In a series of lower urinary tracts taken from unselected consecutive American autopsies, seminal vesicle weight could be correlated with increase in prostatic weight in those tracts with prostatic hypertrophy; the same correlation could not be found in tracts without prostatic hypertrophy. Thus, seminal vesicle hypertrophy appears to correlate with obstructive uropathy in general, not solely obstructive uropathy of schistosomal origin. Digital evaluation of seminal vesicle size may be useful in the clinical evaluation of such patients.

Urogenital myiasis caused by Chrysomya bezziana (Diptera: Calliphoridae) in peninsular Malaysia.

A case of urogenital myiasis caused by Chrysomya bezziana (Diptera: Calliphoridae) was diagnosed in a 76-year old patient who had carcinoma of the rectum. A total of 35 larvae were obtained from ulcers near the external genitalia and urethra opening. Larvae pupated within 1 to 2 days and 6 days later emerged as adult males. These were identified as Chrysomya bezziana. Female flies possibly attracted by the fetid odour, laid eggs in the existing lesions in the urogenital area, the larvae invading and feeding on living tissue. Lack of personal hygiene was the contributing factor for the cause of urogenital myiasis in this patient.