Specific urinary tract infections - Surgery

Question 1

Clinical manifestations of Bilharziasis

Answer 1

1- Initial stage: Swimmer’s itch, due to cercarial skin penetration.
2- Acute stage: Terminal hematuria and dysuria.
3- Stage of complications: signs and symptoms of complications.

Question 2

Complications of bilharziasis

Answer 2

o Urinary Bladder
- Atrophic lesions: ulcerations and contracted bladder
- Hypertrophic lesions: hyperplasia, metaplasia, dysplasia polyposis, and carcinoma.
o Ureters: Ureteral stricture leads to hydroureter and hydronephrosis.
o Genital organs: Hemospermia (blood in the ejaculate) due to involvement of seminal vesicles and the ejaculatory ducts

Question 3

Investigations used in Bilharziasis

Answer 3

Laboratory studies:
- Urine analysis: bilharzial eggs with characteristic terminal spine
- Serological tests: Antibody test is useful but cannot differentiate between active and past infection. Antigen test reflects the presence of active infection.

Imaging studies:
- Abdominal US: focal thickening of the bladder wall, polypoid lesions,
hydroureter, and hydronephrosis.
- KUB: may show calcified bladder.
- CT or IVP: for evaluation of hydronephrosis.

Question 4

Treatment of bilharziasis

Answer 4

-Early treatment, especially in childhood, is the most effective intervention to prevent the development of complications.
-Praziquantel is the drug of choice. Dose: 60 mg/kg in divided three doses 6 hours apart.
-As maturing worms are less susceptible to praziquantel than adult worms, a second course of treatment is necessary after several weeks.

Question 5

C/P of genitourinary filariasis

Answer 5

• Asymptomatic: in endemic areas.
• Lymphangitis-lymphadenitis, funiculo-epididymitis (inflammation of the spermatic cord and epididymis)
• Hydrocele
• Scrotal and Penile Elephantiasis
• Chyluria means leakage of lymph fluid into the urinary collecting system due to rupture of a lymphatic varix. The patient presents with milky urine after fatty meal. Protein & lipid loss, leading to hypoalbuminemia.

Question 6

Treatment of genitourinary filariasis

Answer 6

• Medical treatment: Diethylcarbamazine (DEC), and albendazole together for annual mass treatment in endemic area.
• Endoscopic sclerotherapy for cases of chyluria: Instillation of povidone iodine or glucose 25% into the renal pelvis.
• in March 2018, WHO reported that; Egypt has successfully eliminated lymphatic filariasis as a public health problem. Egypt’s success comes after almost two decades of implementing sustained control mass treatment of populations in affected localities.

Question 7

C/P of GENITOURINARY TUBERCULOSIS

Answer 7

• Microscopic hematuria in 50% of cases.
• LUTS in case of bladder involvement
• In epididymal affection, a painful scrotal swelling, discharging sinus posteriorly and beaded vas.

Question 8

Investigations of GENITOURINARY TUBERCULOSIS

Answer 8

Laboratory studies:
- Urine analysis: Sterile pyuria is the classic urinary finding.
- PCR test is essential for diagnosis.

Imaging studies:
- Ultrasonography: Hydronephrosis and/or renal cavities
- KUB: Calcification in the renal parenchyma and GU tract.
- Chest and spine X-ray: may show pulmonary or spinal disease.
- CT or IVU: Hydronephrosis, pipe-stem like ureter, and/or contracted bladder.

Question 9

Treatment of GENITOURINARY TUBERCULOSIS

Answer 9

Anti-tuberculosis multi-drug treatment is the cornerstone of therapy.
Rifampicin, INH, and Pyrazinamide are the drugs of choice for the first two months, followed by rifampicin and INH for four more months.

Surgery:
1- Nephrectomy: In case of a non-functioning kidney
2-Epididymectomy: If medical treatment fails to cure the discharging sinus.