URINARY-BLADDER BILHARZIASIS AS A CAUSE OF IMPAIRED BLADDER MUSCLE CONTRACTILITY

In an attempt to evaluate the effect of bilharziasis on bladder contra ctility as a factor in the genesis of voiding disorders, 44 cases of b ilharzial bladder neck obstruction diagnosed using traditional methods (symptomatological, radiographic, and endoscopic) were subjected to c omplete urodynamic evaluation (flowmetry, cystometry, pressure/flow st udy, and stop-flow test). Their parameters were compared with those of 28 patients with urodynamically obstructed benign prostatic hyperplas ia and 8 nonsymptomatic controls. Contractility parameters (isometric detrusor pressure, maximum estimated flow rate, detrusor power at maxi mum flow) were calculated for the studied cases and their distribution according to the Schafer pressure/flow diagram was evaluated. Bladder biopsy including the detrusor was evaluated in all 72 patients. Poor bladder: contractility associated with an extensive bilharzial effect on the detrusor muscle was found to be the major abnormality in 20 of 44 patients with presumed bilharzial bladder neck obstruction with no evidence of urodynamic outflow obstruction. We believe such a workup i s essential in cases of suspected obstruction associated with bilharzi asis to throw light on the pathophysiology of the voiding disorders, a void unnecessary surgery, and provide a better prognosis. (C) 1998 Wil ey-Liss, Inc.