Ileal loop replacement and restoration of kidney function in extensive bilharziasis of the ureter

Preliminary nephrostomy and total ileal replacement of both ureters in advanced bilharzial obstructive uropathy

Total substitution of both ureters in 5 patients with advanced obstructive uropathy due to extensive ureteric bilharziasis is described. It is recommended that ureteric replacement in the presence of marked obstructive uropathy should not be undertaken without preliminary renal drainage. An open through-and-through nephrostomy is recommended for this purpose. It is suggested that this approach will help to minimise the incidence of nephrectomy in areas of endemic urinary bilharziasis.

Long-term ureterostomy with suprapubic intravesical drainage used to bypass severe schistosomal obstructive uropathy--preliminary report

Severe obstructive uropathy due to infection with S. hematobium often requires reconstructive surgery. Recent reports, have emphasized that many lesions will disappear after specific chemotherapy given the necessary time. Time for effective chemotherapy may be impossible to allow in severe obstruction. The necessary surgical procedures range from ureteric dilatation to ureteric resection with ileal loop replacement. We suggest that temporary long-term bypass of the diseased ureter using silastic tubes may offer an alternative to resection in many cases while the effect of specific chemotherapy is awaited. One case is described in which ureterostomy with suprapubic intravesical drainage adequately bypassed the diseased and obstructed lower two thirds of the left ureter. In the following six months specific chemotherapy had encouraging effects on the bypassed area.

Fluoroscopic assessment of bilharzial ureteropathy

This paper reports a fluoroscopic study of ureteric peristalsis during intravenous pyelography in 32 patients with urinary bilharziasis and 13 non-bilharzial controls with normal intravenous pyelograms. Ureteric peristalsis is reduced in parallel with urographic signs of involvement. The role of fluoroscopic examination of the ureters in staging bilharzial ureteropathy is discussed.

Bilharzial uropathies and a scheme for primary medical care

Fifty patients suffering from the late effects of urinary bilharziasis were studied. A preliminary idea about the incidence of bilharzial cancer in the endemic area of Jeezan is presented. The role of ileal loop ureteric replacement in extensive ureteropathy is emphasized. A scheme is proposed for the categorisation of bilharzial patients on the basis of their symptoms in order to detect complicated cases at the primary medical care level.

Ileal replacement of the bilharzial ureter: is it worthwhile?

Our 14-year experience with the use of isolated ileal segments for replacement of the bilharzial ureter is analyzed retrospectively. Of 52 patients subjected to this procedure followup data were available for 38, in whom 52 ureters were repaired. The results generally were unsatisfactory: the morbidity and mortality rates were high and the percentage of functional improvement was low. The risk was higher for patients with low creatinine clearance. Therefore, we recommend that this operation be avoided when possible. If the operation is unavoidable, tapering of the ileal segment with antireflux ileovesical anastomosis may improve the outcome. Further clinical study must be done.

Partial flap ureteroneocystostomy for bilharzial strictures of lower ureter

Partial flap ureteroneocystostomy was applied for the management of bilharzial strictures of the lower ureter for 30 ureters (24 patients). Follow-up excretory urography (IVP) showed improvement or stabilization in 83.3 per cent of renoureteral units. Creatinine clearance improved or remained stable in 79 per cent of cases. Postoperative reflux occurred in 30 per cent of renoureteral units. We recommend partial flap ureteroneocystostomy for the management of bilharzial strictures if submucosal tunnel ureteroneocystostomy is not applicable.