Complex ureteral stricture from chronic schistosomiasis requiring ileal ureter interposition: a case report

Troy Sanders, Rachel A. Mann, Molly DeWitt-Foy, Andrew Nguyen, Joseph J. Pariser

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Schistosomiasis is most notably associated with squamous cell carcinoma of the bladder, and it is estimated that approximately 10% of people infected will develop a urologic complication. Ureteral pathology is rare and has only been described in a handful of case reports. Increasing awareness of this condition is needed given a recent increase in sub-Saharan immigrant population in the United States (US), as prompt recognition is key to providing optimal care. Case Description: A 40-year-old Kenyan immigrant presented to the emergency department with left-sided flank pain and was found to have left hydronephrosis and three mid-ureteral calcifications. He underwent ureteroscopy where the left ureter appeared blind-ending just proximal to the iliac vessels. A percutaneous nephrostomy tube was placed, and renal pelvis urine was analyzed for mycobacterium tuberculosis and acid fast bacilli which were negative. Antegrade ureteroscopy demonstrated a second, proximal ureteral stricture with a pinpoint lumen. Antegrade and retrograde pyelography revealed a 3 cm mid-ureteral stricture with no contrast passage. Given the stricture length, multifocality, and unclear pathology, we opted to perform ureterectomy with ileal interposition. Final pathology revealed schistosomiasis with calcifications. The patient received two doses of Praizquantel and his stent was removed 6 weeks postoperatively. He is doing well without complications. Conclusions: There is a wide range of urologic complications caused by schistosomiasis infection, and this case highlights an extreme case. Although many patients will present with a fixed urologic complaint, they remain at risk for additional urologic pathology in the future without antihelminthic therapy. This highlights the need for an accurate diagnosis and a high index of suspicion for at-risk populations.

Original languageEnglish (US)
Pages (from-to)1199-1203
Number of pages5
JournalTranslational Andrology and Urology
Volume12
Issue number7
DOIs
StatePublished - Jul 2023

Bibliographical note

Publisher Copyright:
© Translational Andrology and Urology. All rights reserved.

Keywords

  • Schistosomiasis
  • case report
  • ileal ureter
  • reconstructive urology
  • ureteral stricture

PubMed: MeSH publication types

  • Case Reports

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