[Parasitic disease of urinary tract system (on the example of schistosomiasis)]

INTRODUCTION

The globalization observed in the modern world contributes to the increasing rate of the delivery of "exotic" bacterial and parasitic infections from the tropic countries to Russia and the European countries.

AIM

To analyze the modern early diagnostic tools of premalignant changes and malignant tumors of urinary bladder of schistosome origin in the residents of endemic areas.

MATERIALS AND METHODS

The current study included an analysis of examination and treatment of 181 patients with bladder schistosomiasis who lived in Benguela province in Angola. In 39 cases (21.5%) bladder cancer associated with schistosomiasis was detected. All patients were undergone to surgical treatment. 142 patients (78.5%) were divided into two groups. In Group 1 (n=74) patients had uncomplicated bladder schistosomiasis and in Group II (n=68) the patients with granulomatous inflammatory changes in the urinary bladder were included.

RESULTS

The patients with bladder schistosomiasis (n=142) were undergone to outpatient examination. In 38 cases (26.8%) the cytologic study of urinary sediment (CSUS) revealed the schistosomes eggs. With ultrasound study, the specific granulomatous changes in the mucous membrane of urinary bladder were detected in 28 cases (19.7%) while hydronephrosis, calcifications and thickening of bladder wall was diagnosed in 7 (4.9%), 10 (7%) and 99 (69.7%) patients, respectively. During cystoscopy the granulomatous changes in the bladder were found in 68 cases (47.9%). In Group I patients received "Praziquantel" in combination with oral antibiotic therapy, which resulted in resolution of gross hematuria and dysuria. All patients in Group II (n=68) were also administered antibacterial and antiprotozoal therapy. An additional 35 patients (24.6%) were undergone to transurethral bladder resection. Of 33 patients in Group II (23.2%) who received only antibacterial and antiprotozoal therapy the granulomas persisted in 7 cases (4.9%) and, therefore, TURB was performed. The subsequent studies showed the regression of the lesions in these patients.

CONCLUSION

CSUS and ultrasound study are not sufficient for diagnosis of bladder schistosomiasis. Cystoscopy is recommended for all patients, since it allows to evaluate bladder volume and to determine the indications for TURB in addition to antiprotozoal and antibacterial therapy.