Ureters

The earliest change in the ureters is persistent filling of the lower segment in all films of the urography series. At this stage the ureters are not dilated or otherwise abnormal in many patients, but dilatation of the filled distal, intrapelvic segment is the next change (Fig. 2.10). The widening may be slight or marked, but there may be no visible stenosis. The earliest ureteric constriction is within the bladder wall, and there will also be changes in ureteric peristalsis. This has been confirmed by fluoroscopic studies.

....

...

..

Fig. 2.10 A-F. The early changes in schistosomiasis of the ureter. A,B Intravenous urograms of two African men. Kidneys are normal, but both ureters are filled throughout their length and the lower thirds are dilated, irregular, and show beading due to multiple intrinsic constrictions. Their bladders do not show any calcification. C In another patient there is narrowing of both ureters close to bladder and in the right ureter there is a segment of dilatation between two areas of stenosis, with dilatation also above the upper narrowing. D Persisitent filling in the lower half of both ureters, with a long constriction in the right ureter just above the bladder. Both show irregular areas of constriction and dilatation. E As this bladder fills, the lower ureters are irregular, with the left more dilated than the right. F After micturition (same patient as E) the bladder is empty, the right ureter is irregular but normal in diameter, whereas the left ureter is persistently filled and dilated, with a long constriction close to the bladder.