Bilharzial strictures of the lower third of the ureter: a critical review of 560 strictures.

In a series of 329 patients with urinary bilharziasis, 560 strictures occurred in the lower third of the ureter. Bilateral ureteric involvement was seen in 231 patients (70.2%). Two hundred and fifty-two strictures (45%) were juxtavesical, 210 (37.5%) intramural, 50 (8.9%) were combined juxtavesical and intramural, 43 (7.7%) were pelvic and 5 (0.9%) were ureteric meatal strictures. The main operative procedures were pull-through ureteroneocystostomy (47.1%), ureteric reimplantation into the dome of the bladder (28.8%) and nipple ureteroneocystostomy (20.3%). Post-operative complications occurred in 17 patients (5.2%) and the operative mortality was nil. It is concluded that the best results are achieved through selection of the appropriate operative procedure and prevention of reinfestation.