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