The continuing challenge of bilharzial ureteric stricture

The commonest urologic complication in 176 cases of chronic urinary bilharziasis was ureteric stricture (87 ureters in 55 patients), with the lower third of the ureter affected in 87% of the cases. Other complications included squamous-cell carcinoma of the bladder, urinary calculi and bladder calcification. Intravenous urography and cystoscopy were the most useful diagnostic methods in 76% of the cases. Post-micturition erect urography and frusemide intravenous urography gave great help in distinguishing between true mechanical and non-mechanical ureteric obstruction in patients with dilated pelvicalyceal system on conventional urograms. Only 17 of 68 dilated ureters were truly obstructed and required excision and ureteroneocystostomy. Postoperative vesicoureteric reflux developed in four of these cases. No deterioration of renal function occurred in the remaining, conservatively treated patients.