Diagnosis

• Diagnosis of infection
  • Urine sediment reveals terminally spined eggs of S. haematobium (midday urine sample is most diagnostic)
  • Rectal or bladder mucosal biopsy to look for eggs
  • Serologic tests are not yet completely reliable. However, the new and developing DNA probes may become useful in the future for the diagnosis
• Diagnosis of sequelae and complications
  • Plain x-ray of abdomen classically reveals bladder calcification. Seminal vesical, urethral, and distal ureteral calcification may be seen
  • IVU is essential to look for obstructive uropathy. More recently, CT scanning and ultrasound have been employed for the detection of obstructive and destructive lesions
  • Cystoscopic appearance

Medical management

• S. haematobium is sensitive to metrifonate (Bilharcil), praziquantel (Biltricide), hycanthone mesylate (Etrenol), niridazole (Ambilhar), and Oltipraz
• Praziquantel, a heterocycline prazinoisoquinoline
  • Drug of choice for treatment of all species
  • Dosage for S. haematobium is 40 mg/kg by mouth in single dose
• Metrifonate (7.5 to 10 mg/kg)
  • Drug of choice for endemic infections caused by S. hematobium
  • Dosage is given in three oral doses at 14-day intervals
• Niridazole (Ambilhar) is a nitrofuran
  • Dosage is given orally in two divided daily doses of 25 mg/kg per day for 5 to 7 days.
• These drugs may have many side effects, and in edemic areas the clinician must be cognizant of risk-benefit ratios, as low-level infection is well tolerated by many persons and generally will not produce symptomatic chronic disease or chronic obstructive uropathy

Surgical management

• Surgical procedures are reserved for complications of infection such as:
  • Ureteral stenosis
  • Bladder fibrosis
  • Bladder carcinoma
• Procedures include:
  • Ureteral dilatation
  • Ureteral reimplantation
  • Partial cystectomy
  • Bladder augmentation
  • Cystectomy with urinary diversion

References

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