Evaluating bilharzial ureteropathy for surgery.

In a study of 115 ureters showing chronic bilharzial changes, 4 main patterns of ureteropathy are defined. Type A is benign, shows mild fusiform dilatation localised to the distal ureteric segment and requires no surgery. Type B presents with distal ureteric stricture, without extensive fibrosis, is rare, and shows good results following resection and ureterovesical reimplantation. Type C shows extensive bilharzial changes without stricture and is difficult to evaluate unless fluoroscopy is added to standard urographic investigation. If peristaltic dysfunction is severe, these ureters will require placement with an ileal segment. Type D ureteropathy presents with fixed tortuosity, mainly in the upper ureteric segment, and conservative surgery, involving freeing and straightening the entire ureter, has shown good results. Staging the presenting ureteropathy has proved valuable in evaluation and follow-up.