A pt. Ramu presents with hematuria for many days. On investigations he is found to have renal calculi, calcifications in the wall of urinary bladder and small contracted bladder; most probable cause is ?
Ans. is 'a' i.e. Schistosomiasis Now here, is confusion in the question itself. There are two opinions among students (a) One group of students say that the question was small contracted bladder with calcified lesion in the kidney (b) Others opinion there is that the question was - small contracted bladder with calcification in the wall of bladder itself Ans to (a) is Tuberculosis Ans to (b) is Schistosomiasis Schistosomiasis of the bladder The common species of Schistosoma are - S. Japonicum (affecting mainely liver, S. intestine)* - S mansoni (affecting mainly large intestine)* - S. haematobium (affecting mainly the bladder)* The adult S. haematobium worm lives in the prostatovesical plexus of veins. The female worm lays her eggs in the subepithelial layers of the affected viscus. Massive egg deposition leads to severe local reaction with granuloma formation.these are later replaced by fibrous tissue that causes contraction of different pas of the bladder and stricture of ureter. Fibrosis and massive egg deposition interfere with the blood supply of area causing chronic bilharzial ulcerations. Epithelial metaplasia is common and squamous cell ca is a frequent sequela. Secondary inf. of the urinary tract is a common complication. The trapped dead ova become impregnated with calcium salts and forms sheets of subepithelial calcified layer in the bladder wall. This appear on xrays as dense concentric ring of calcification (may resemble featal head in pelvis). Profuse hematuria occurs in patients initially due to penetration of the urothelium by living ova (which are extruded in the urine) and later due to ulceration. Both renal and vesical calculi may form. Advanced ds. leads to small contracted bladder (having a capacity of only few millilitres) with varying degrees of dilatation of the upper urinary tract (hydroureteronephrosis) S. haematobium also involves ureters, seminal vesicles (and to a lesser extent male urethra and prostate gland) leading to strictures and extensive calcifications in these structures. Tuberculosis of kidney and bladder In TB of kidney, a group of tuberculous granulomas form in the renal pyramid. They coalesce and form an ulcer. Untreated the lesion enlarges and a tuberculous abscess may form in the parenchyma. Gradually the kidney is replaced by caseous material (putty kidney*), it may be calcified (cement kidney). Calcifications may appear on the x-ray as calculi (pseudocalculi) Renal tuberculosis is often associated with tuberculosis of the baldder. TB of bladder leads to fibrosis and thus contracture of bladder. Golf-hole ureters* are seen in TB bladder*.
Schistosomiasis
Amyloidosis
Tuberculosis
Ca urinary bladder