Urological findings and surgical procedures in immigrants from sub saharan africa to europe with genito-urinary schistosomiasis

Aim of the study: Most people affected by genito-urinary schistosomiasis (GUS) come from Sub-Saharan Africa (SSA). In recent years an unprecedented migratory flux from SSA to Europe has been recorded. The aim of this study is to describe the urological findings and the surgical procedures in adult SSA immigrants with suspected or diagnosed GUS in a single tertiary referral centre and to evaluate the need of a surgical approach in selected cases. Materials and methods: All immigrants from SAA diagnosed with schistosomiasis based on positive serology and/or parasitological examination of urine or stool and/or compatible histological exam from January 2011 to November 2018 were enrolled retrospectively. Patients with GUS were identified by the presence of specific laboratoristic signs or symptoms such as haematuria, microhematuria, presence of Schistosoma ova in urine, genito-urinary ultrasound (US) findings. All patients were treated by the time of diagnosis with praziquantel 40 mg/kg/day in 2 doses for 3 days and follow-up was scheduled at 1–2 and 6 months. In case of persistent haematuria or US lesions at follow-up cystoscopy was done and in presence of suspected tumor lesions forms or organ damage, surgical procedures were performed. In some urgent cases of profuse hematuria ndd or suspected tumoral lesions at the first visit in the clinic, medical treatment was made after surgery. Results: Clinical data were summarized in table 1. 52 male were diagnosed with schistosomiasis, among them 28 (53.8%) had GUS; of these 12 (42.8%) were submitted to surgery. Mean age at surgery was 24 years (range 20–29). The onset GUS related symptoms were haematuria in 6 patients (50%), urinary symptoms in the other 6 (50%). 9 patients underwent surgery after medical treatment (75%); 3 (25%) had surgical procedures before for urgent management of haematuria. Surgical procedures were: 9 (75%) trans urethral resection bladder (TURB) for suspected lesions, 1 (8%) endoscopic lithotripsy and 1 (8%) PCN-L lithotripsy for bladder and renal stones, 1 (8%) laparoscopic nephrectomy for end stage kidney and 1 (8%) orchiectomy for a suspected testicular torsion. Only 1 complication (8%) was detected (conspicuous hematuria after TURB leading to anemia and requiring blood transfusion). 10 patients submitted to histological analyses: 9 (75%) had histological findings of GUS and 1 (8%) had intestinal metaplasia. 2 (16%) were lost at the follow up. Discussion: An increasing number of immigrants from SSA diagnosed with GUS has been observed. Some patients required a surgical treatment, as a feasible and safe option in presence of suspected lesions for related tumour forms or organ damage; in these cases histopathological analyses confirms the GUS diagnosis. It was particularly difficult to perform a regular follow-up in these patients and further multicentric studies in low endemic countries are needed, to reach a proper standard for diagnosis, treatment and follow up for patients with GUS.