Potpourri Friday, September 17, 2004

Abnormal Pelvic Calcifications Phleboliths Nephro/ureterolithiasis oxalate>cystine>urate Bladder wall calcifications Bladder stones Tumors (GU, Gyn, GI)

Schistosomiasis Trematode (fluke) Snails as intermediate host female produces 300 eggs/d 200 million worldwide infected Africa, S. America, Asia worm lifespan 5-10 yrs Set up in vesical venous plexus haematobium mesenteric plexus japonicum mansoni mekongi intercalatum

Schistosomiasis Turn into cercaria in snail liver S. haematobium penetrate skin/membranes and via lymph to vesicular plexus. dysuria, haematuria, anaemia, or hydronephrosis. Carcinoma of the bladder S. haematobium Bilharzia East Africa, Asia, Mediterranean, Arabia Ova deposited by female fluke in bladder wall, passed Miracidia develop in ovum in water

Urinary Schistosomiasis Diagnosis urine for eggs (midday) serology Praziquantel 20mg/kg, 2 doses in 1 day

Figure 68-22 Bilharzia. Bladder calcification.

Schistosomiasis calcification of the bladder wall in a band 1–3 mm wide areas of calcification are located in submucosa filling defects due to granulomas from allergic reaction. Strictures more commonly involve the bulbar urethra and are secondary to the fistulous tract formation ureteritis cystica parallel lines seen in ureters

Figure 70-16 (A) Irregular calcification of a bladder tumour (arrow) Figure 70-16 (A) Irregular calcification of a bladder tumour (arrow). (B) After contrast medium the whole of the bladder appears abnormal, a finding subsequently confirmed at cystoscopy.

Figure 72-10 Urinary schistosomiasis Figure 72-10 Urinary schistosomiasis. Calcification within the bladder wall (open arrows) and ureter (solid arrows) characteristic of schistosomiasis infection

Urinary Tuberculosis descending infection renal, bladder, and prostatic involvement early stages bladder trabeculation later stages thick-walled w/small capacity may calcify Anterior urethral strictures periurethral and periprostatic abscesses perineal and recto- urethral fistulas