LETTER TO THE EDITOR
|Year : 2017 | Volume
| Issue : 4 | Page : 258-259
Schistosomiasis: A rare cause of meatal stenosis!
Meera Luthra1, Ritesh Sachdev2, Shalini Goel2
1 Department of Pediatric Surgery, Medanta The Medicity Hospital, Gurgaon, Haryana, India
2 Department of Pathology, Laboratory Medicine and Transfusion Medicine, Medanta The Medicity Hospital, Gurgaon, Haryana, India
|Date of Web Publication||12-Sep-2017|
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Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Luthra M, Sachdev R, Goel S. Schistosomiasis: A rare cause of meatal stenosis!. J Indian Assoc Pediatr Surg 2017;22:258-9
Meatal stenosis is one of the most common presentations for benign (infective) and malignant conditions of the urinary tract. Schistosomiasis is not endemic in India, hence not usually considered. Due to the influx of patients from other countries, sometimes, conditions not native are encountered and hence should be considered as causative factors.
| Presentation|| |
A 14-year-old immune-competent boy presented 8 months back with thin urinary stream for which diagnosis of meatal stenosis was given. He had an uneventful circumcision at birth. At 8 years, he developed meatal stenosis for which meatotomy was done. Subsequently, he was well for 2 years when he developed a thin urinary stream again. He had terminal hematuria 2 months ago, three episodes in 3 days. On examination, the meatus admitted a size of 6 Fr tube only. The hematological and biochemical parameters including renal function tests (RFTs) were normal. Urine examination with culture was normal. Micturating–cystourethrogram and ultrasound of kidney and bladder were normal. Cystoscopy followed by meatoplasty was done. At surgery, both ureters were normal. There were diffuse yellow patches seen in urinary bladder mucosa [Figure 1]a; biopsy was done and sent for histopathology. The biopsy revealed bladder wall with underlying subepithelium infiltrated by acute and chronic inflammatory cells, foreign body material with multiple oval-shaped eggs of schistosoma hematobium with calcification [Figure 1]b.
|Figure 1: (a) Cystoscopy shows yellow patches in the bladder wall (left side) with a large yellow patch near the right ureteric orifice (right side). (b) Microscopy shows calcified ova of schistosoma surrounded by chronic inflammatory infiltrate|
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| Management|| |
The child recovered uneventfully and was given two doses of praziquantel (400 mg), 4 h later. On follow-up, the child was asymptomatic with the normal urinary stream, RFT, and urine examination. Ultrasound done after 6 months, revealed mildly increased echogenicity in right kidney with mildly obliterated corticomedullary differentiation suggestive of early/mild renal parenchymal disease. On cystoscopy, persistent yellow patches in the bladder wall, especially above the right ureteral orifice [Figure 1]a, were seen. Repeat biopsy showed similar histomorphology as above.
| Effect of Parasite on the Urinary Tract|| |
Diagnosis is by finding eggs of parasite in urine/stool of the patient. The pathognomonic feature is egg granuloma as a consequence of delayed hypersensitivity response to schistosomal egg antigen secreted by the egg resulting in inflammation and fibrosis. The sequel of infection is inflammation followed by calcification, fibrosis leading to contracted bladder, back pressure changes in the kidneys as seen in the present case. These features have been described in the bladder mucosa in the literature; the authors postulate that as the mucosal lining is similar in meatus, the same mechanism occurred here leading to stenosis.
Schistosomiasis, is one of the oldest parasitic infestations, affects commonly people in Africa (85%); prevalence in India is not well documented. On the basis of terminal hematuria, and the patient was an African resident, cystoscopy was done even despite urine routine being normal. We postulate that the child suffered from schistosomiasis for the past 2 years; which lead to both the episodes of meatal stenosis. There is no reason to develop meatal stenosis because of the uneventful circumcision which was done at birth. Thus, schistosomiasis should be considered as a cause of meatal stenosis, which if not treated can progress to contracted bladder and malignancy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kali A. Schistosome infections: An Indian perspective. J Clin Diagn Res 2015;9:DE01-4.
Thétiot-Laurent SA, Boissier J, Robert A, Meunier B. Schistosomiasis chemotherapy. Angew Chem Int Ed Engl 2013;52:7936-56.