Bladder outlet obstruction; a rare complication of the neglected schistosome, Schistosoma haematobium: two case reports and public health challenges.

BACKGROUND: Schistosomiasis is a severe parasitic infestation with debilitating complications and is the third most devastating tropical disease in the world. It is one of the neglected tropical diseases (NTDs) with a high disease-burden. We present two rare cases of bladder outlet obstruction: one which led to a chronic kidney disease and ultimately death and a second which recovered after treatment with praziquantel. CASE PRESENTATIONS: A 72 year old male presented with lower urinary tract symptoms which culminated in an episode of acute urinary retention. The patient had never received preventive chemotherapy with praziquantel. After suprapubic aspiration, the cause of the obstructive uropathy was found to be several mature live worms of Schistosoma haematobium. Despite treatment with praziquantel and haemodialysis; we lost the patient due to sepsis from a urinary tract infection. In the second case, a 15 year old male presented with LUTS for a 1 year duration and was diagnosed to have schistosomiasis after eggs of Schistosoma haematobium were found in his urine. He was treated with praziquantel. CONCLUSION: There are several gaps in the public health policies in place to control this NTD in Cameroon as annual distribution of preventive chemotherapy is inadequate due to inaccessibility of some high-endemic zones and is based on data obtained two decades ago. Population education is insufficient leading to poor health-seeking behaviour. These gaps in public health policies need to be addressed to aid in the overall achievement of the sustainable development goals.

The unacknowledged impact of urinary schistosomiasis in children: 5 cases from Kumasi, Ghana.

Urinary schistosomiasis is a parasitic disease caused by Shistosoma haematobium. It is prevalent in several parts of Africa particularly in areas where there are large water bodies. In most affected communities, the condition is often accepted as normal since to them, all growing children pass blood in their urine and "grow out of it". Mass treatment of school children has been a regular exercise often undertaken by stake holders to decrease the disease burden and reduce transmission in selected communities. Urinary schistosomiasis can have devastating impact on the urinary tract which is often unacknowledged and unevaluated. Such omission could have implication for progressive renal damage which, if not detected and treated, could lead to end stage renal failure and death. We present five (5) cases of urinary schistosomiasis with severe obstructive uropathy seen at the paediatric nephrology/urology units of Komfo Anokye Teaching Hospital, Ghana. All five cases had some degree of anaemia and hypertension. Two of the five cases presented with end stage renal failure and died subsequently whilst two underwent successful surgery. One made a spontaneous recovery from the urinary obstruction though still has significant renal impairment. This potential devastating effect of urinary schistosomiasis on the kidneys calls for thorough evaluation and assessment of each confirmed case to include blood pressure measurement, full blood count, and ultrasonography of the urinary system. Mass screening programmes should be combined with portable ultrasonography of the kidneys, ureters and bladder.

Unusual bladder outflow obstruction: case report.

Hydatid disease, the parasitic infestation caused by the cestode, echinococcus granulosus involves mainly the liver and the lungs though no organ is immune. Genito urinary involvement has been found mainly in the kidneys and rarely in other structures such as, bladder and epididymis. Isolated retrovesical location of the hydatid cyst is a very rare condition whose manifestations appears after a long course of the disease and are due to compression of bladder, causing the bladder out flow obstruction. Such rare case of bladder out flow obstruction is presented.

Urinary bladder bilharziasis as a cause of impaired bladder muscle contractility.

In an attempt to evaluate the effect of bilharziasis on bladder contractility as a factor in the genesis of voiding disorders, 44 cases of bilharzial bladder neck obstruction diagnosed using traditional methods (symptomatological, radiographic, and endoscopic) were subjected to complete urodynamic evaluation (flowmetry, cystometry, pressure/flow study, and stop-flow test). Their parameters were compared with those of 28 patients with urodynamically obstructed benign prostatic hyperplasia and 8 nonsymptomatic controls. Contractility parameters (isometric detrusor pressure, maximum estimated flow rate, detrusor power at maximum flow) were calculated for the studied cases and their distribution according to the Schafer pressure/flow diagram was evaluated. Bladder biopsy including the detrusor was evaluated in all 72 patients. Poor bladder contractility associated with an extensive bilharzial effect on the detrusor muscle was found to be the major abnormality in 20 of 44 patients with presumed bilharzial bladder neck obstruction with no evidence of urodynamic outflow obstruction. We believe such a workup is essential in cases of suspected obstruction associated with bilharziasis to throw light on the pathophysiology of the voiding disorders, avoid unnecessary surgery, and provide a better prognosis.

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.