Prevalence and intensity of urinary schistosomiasis among selected people in Tulus area, South Darfur State, Sudan

Background: Urinary schistosomiasis is a major public health issue in Sudan. The disease is endemic in many rural communities across the country.Methods: This is a cross-sectional study conducted to determine the prevalence and intensity of urinary schistosomiasis among selected individual in the city of Tulus, South Darfur state, Sudan. One hundred terminal urine samples were collected and examined for Schistosoma haematobium eggs using standard filtration technique.Results: A total of 100 individual were enrolled in the study with a mean (±SD) age of 17.7±0.73 years. Out of them, 62 (62%) were found to be infected with Schistosoma haematobium. The statistical analysis showed significant association with gender (p=0.043) with higher prevalence 70.9 % (39/55) in female than males 51.1 % (23/45). Majority of the S. haematobium infections were classified as intense infection (82%, 51/62) with egg count ≥50 eggs/10 ml urine, while gross haematuria was observed in 10% of urine samples.Conclusions: In conclusion, the prevalence of S. haematobium infection in the study participants was remarkably high. However, further studies, including large sample size will be essential to assess the burden of the disease in the study area.

Preliminary Study on Human Host Factors Perpetuating the Transmission of Schistosomiasis in Endemic Community of Wudil, Kano State, Nigeria

Objective: A cross-sectional study was conducted to determine the human host factors that contribute to the perpetuation of schistosomiasis transmission in endemic communities of Wudil, Kano State, Nigeria. Methods: Information was derived from structured questionnaires supplemented with oral interviews, on perception of the community on the cause of urogenital schistosomiasis, using self-reported macrohaematuria, as the disease proxy, water-use practices, riverside urination and defaecation, and the choice for treatment of schistosome infection. Results: Out of 139 study participants, the perceived causes of gross haematuria by the respondents were Excessive Salt Intake (41.73%); Scorching Sun (20.86%); Unknown (17.27%); Infection (10.07%); Supernatural Force (5.86%) and Water Contact (4.32%). The respondents with self-reported terminal haematuria were 49.64%; riverine water contact 75.54% and riverside contamination 65.41%. Of the 72.46% of the respondents with gross haematuria who attempted for medication only 8.0% visited health facilities, while majority relied on traditional herbalists (39.13%) and roadside medicine stores (20.29%) for treatment. There was a strong association between riverine water contact and terminal haematuria (Odds Ratio: 6.09, 95% CI, 2.825-13.131, P<0.0001; Relative Risk: 2.737, 95% CI, 1.664-4.502, P<0.0001). Conclusion: Exposure to contaminated water as a result of socioeconomic activities, riverside, poor perception on the cause of the disease and lack of adherence to orthodox treatment of positive cases are the key promoters of schistosomiasis transmission in the study area. Excessive salt intake and scorching sun are the major perceived causes of haematuria among the study participants. This underpins the need for health education and other efficacious interventions for community awareness on the disease etiology which is central to effective elimination campaign.

Sarcomatoid urothelial carcinoma of the bladder with osseous metaplasia: bone in urinary bladder

Sarcomatoid urothelial carcinoma is a rare aggressive malignant neoplasm of the urinary bladder. It usually presents at an advanced stage and thus carries a poor prognosis. These tumours are usually managed with multimodal therapies such as cystectomy and chemotherapy. In the present case, a 72-year-old man presented with gross haematuria and was diagnosed as sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation and extensive stromal osseous metaplasia. The patient was managed with transurethral resection of bladder tumour (TURBT), followed by intravesical chemotherapy. The patient is doing well post 14 months follow-up. Hence, complete TURBT with chemotherapy is also a viable option for patients who prefer to preserve bladder.

PREVALENCE OF SARCOMATOID CARCINOMA OF URINARY BLADDER IN NORTH WEST RAJASTHAN: A FIVE YEARS RETROSPECTIVE STUDY AT OUR INSTITUTE

Background: Sarcomatoid carcinoma is an uncommon malignancy, represents only 0.1% to 0.3% of carcinomas. Methods: The medical records of all the patients who underwent consecutive cystectomy and the TURBT specimen sent to pathology department of Sardar Patel Medical College, Bikaner, were retrospectively analysed. Detailed medical history was noted age, gender, indication for surgery, surgical procedure, tumour localization in the urinary bladder, diameter of the lesion after fixation with 10% formalin, and overall incidence of tumour reviewed in detail. Results: Out of the total 541 patients, 41 were found to have histological evidence of benign lesions of the urinary bladder, hence not included in the study. Out of 500 patients of urinary carcinoma 1 patient was found to have histological evidence of sarcomatoid carcinoma which was further confirmed by immunohistochemistry. The patient was 29 years old male. Gross haematuria was the clinical presentation. Radical cystectomy was performed. The tumour was polypoid, located on left posterolateral wall of the bladder with dimension of 10X7X6 cm. Conclusion: Sarcomatoid carcinoma is a rare variant with different therapeutic and diagnostic implications, presenting with gross haematuria. Sarcomatoid carcinoma was diagnosed on histological and immonohistological staining.

Transitional cell carcinoma of the upper urinary tract: a puzzle

Transitional cell carcinoma (TCC) of the upper urinary tract has a puzzling presentation. This is a case report of a 44 year old male with history for smoking 20 pack years presenting with cough, haemoptysis and microscopic haematuria. His sputum was positive for acid fast bacilli. He was treated as pulmonary tuberculosis (PTB) but had gross haematuria a month after initiation of anti-tubercular drugs (ATD). He was investigated with computed tomography (CT) imaging and was found to have thickened renal pelvis and ureter. It was initially thought as a case of genito-urinary tuberculosis (GUTB). Expectant management for gross haematuria failed. The patient was stabilised and taken up for open nephroureterectomy under general anaesthesia (GA). Histopathological report suggested it to be high grade TCC of the left renal pelvis extending to upper ureter. He did well with completion of ATD. He was not started on adjuvant chemotherapy for fear of exacerbation of PTB. He is under regular and uneventful follow up in the outpatient department (OPD).

Uretero-Iliac artery fistula: a rare cause of haematuria

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

Bacteria-ball in the urinary tract: a rare entity

A bacterial mass in the urinary tract is a very rare entity. We report the first case of a bacterial ball within the urinary tract of a patient with diabetic cystopathy on long term urinary indwelling catheter. She presented with fever and gross haematuria. CT scan of abdomen and pelvis revealed a gas containing hyperdense mass within the bladder suspicious of bladder stone. The lesion was resected, and histopathology revealed a matrix of acellular materials with bacteria colony.

Pre-Clinical Proof-of-Concept Study of a Bladder Irrigation Feedback System for Gross Haematuria in a Lab Setup

Conventional continuous bladder irrigation (CBI) systems used in Urology have been labor-intensive and challenging for healthcare workers to manage consistently due to inter-observer variability in interpreting the blood concentration in the drainage fluid. The team has come up with a feedback system to control the saline flow-rate. It consists of a sensor probe that measures blood concentration in drainage fluid by measuring the light intensity absorbed by the samples. The other component is a gripper that adjusts the saline flow-rate based on the blood concentration detected. Results have shown that probe utilizing green color LED light can measure blood concentration between 0 and 18 percent. Besides, the gripper actuates to the blood concentration values detected accordingly. The quantification process reduces or even eradicates human error due to the subjective assessment of individual medical professionals.

Imatinib-induced haematuria necessitating drug discontinuation

Gastrointestinal stromal tumours are rare neoplasms of the gastrointestinal tract that are mesenchymal in origin. The introduction of tyrosine kinase inhibitors resulted in significant improvement in survival of patients with gastrointestinal stromal tumour even in advanced disease conditions. A 43-year-old adult male who is a known case of gastrointestinal stromal tumour of the stomach, on adjuvant therapy with imatinib, presented with a history of gross haematuria of several episodes as well as persistent microhaematuria and was evaluated for the same. He was investigated for all possible causes, but all were negative. The patient was advised to withhold imatinib. Haematuria resolved 1 month after stopping imatinib. Then it was rechallenged. He had recurrence of symptoms, so it was discontinued. In view of the temporal relation of haematuria and administration of imatinib, a diagnosis of imatinib-induced haematuria was made.

Giant ureteral fibro-epithelial polyp: A rare but important differential of ureteral urothelial cell carcinoma

Background: Fibro-epithelial polyps (FEPs) of the ureter are rare benign tumours and constitute an important differential for ureteral urothelial cell carcinoma (UCC). Case presentation: We describe a case of a 56-year-old lady presenting with gross haematuria. On initial evaluation elsewhere, she was diagnosed with lower ureteric UCC and was advised left nephroureterectomy. Careful evaluation at our centre established the diagnosis of a left ureteral FEP. Robot-assisted excision of the ureteral FEP was successfully done. Conclusion: Diagnosis of these rare tumours may be made with a combination of imaging, ureteroscopy and histopathological analysis. Resection of giant FEPs may be done with a robot-assisted technique. Proper diagnosis and management of these tumours are essential to avoid unnecessary nephroureterectomies. Level of evidence: 4