The Natural History of Ureteric Bilharzia

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Abstract
A prospective study of apparent obstruction of the ureter by Bilharzia was undertaken. Over a 2-yr period, 130 patients with active Bilharzia and 58 patients with inactive or chronic Bilharzia, all of whom had apparently obstructive lesions of the ureter, were studied. Ureteric lesions were examined for true mechanical obstruction by post-micturition erect radiography, erect diuresis renography and, in selected cases, by perfusion pressure flow studies. Of the 130 patients with active Bilharzia, 32 ureters were mechanically obstructed and in each case the obstruction resolved with anti-bilharzial medication. Of the 58 patients with chronic or inactive lesions, only 5 ureters were truly obstructed and required surgery. Surgery is unnecessary for ureters obstructed by active Bilharzia within 2 mo. of starting treatment because the obstruction will resolve in most patients. In the so-called chronic bilharzial stricture, obstruction is more apparent than real and thorough investigation will save many patients from unnecessary surgery.

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