BILHARZIASIS OF THE TESTIS

By WILLIAM HOUSTON, M.D., M.Ch., F.R.C.S., F.R.C.S.I. Bulawayo, Southern Rhodesia

ALTHOUGH vesical bilharziasis is extremely common in this country, especially among the African population, it is unusual to find much spread to the lower urinary or genital tract, and contrary to the experience of Makar (1955), it is seldom found in the epididymis or testis. In the course of numerous biopsies carried out to elucidate the nature of chronic epididymitis, I have found Schistosoma hmmatobium on only one occasion, an experience shared by Honey and Gelfand (1 960).

Fig. 1 .-Excised testis.

Fig. 2.-Bilharzial pseudo-tubercles, showing dead ova and giant cell. ( -90.)

Fig. 3.-Ova of S. hematobiurn ; the terminal spine shows clearly on the unbroken ovum. ( x 365.)

FIG. 1

FIG. 2 220

FIG. 3

B I L H A R Z I A S I S O F THE TESTIS 22 1

The following case is therefore reported because of its rarity. The patient, an African boy aged 10 years, was referred to me for correction of a mild hypospadias in January 1962. Examination also revealed that the right testis was undescended and impalpable.

At operation for correction of the ventral curvature of the penis, the right inguinal region was also explored. There was no testis or spermatic cord in the canal, but at a deeper level the testis was found. It was enlarged to about twice the usual size and appeared grossly abnormal. It lay in close relation to a very thickened bladder wall which it appeared to be infiltrating. On the provisional diagnosis of tumour, the testis was therefore removed with a cuff of bladder and the wound closed.

“ The testis (Fig. 1) is completely replaced by bilharzial pseudo-tubercles. The bladder wall shows heavy deposits of ova of S. hmnatobium ” (Figs. 2 and 3).

The child made an uneventful recovery, and was discharged after treatment of his bilharziasis. The interest of the case lies in the probability that the abnormal position of the testis, or

possibly a shorter venous pathway, allowed the parasites to invade and destroy the gland. Direct extension from the bladder wall is unlikely, as such spread does not normally occur.

The pathological report on the excised specimen was as follows (Dr D. Parker).

REFERENCES

HONEY, R. M., and GELFAND, M. (1960). ‘ I Urological Aspects of Bilharziasis in Rhodesia.”

MAKAR, N. (1955). ‘‘ Urological Aspects of Bilharziasis in Egypt.” (Cairo : S.O.P. Press.) (Edinburgh and London : E. & S. Livingstone.)