Filariasis is one of the oldest diseases in the world. It is an endemic problem in our country. Filariasis is an important clinical problem and often encountered by the Urologists all over the country. It is a mosquito-borne parasitic disease caused by three lymphatic dwelling nematodes namely Wuchereria bancrofti, Brugia malayi and Brugia timori. W bancrofti accounts for 90% of human cases. Filariasis may cause acute lymphangitis and lymphadenopathy or chronic lymphatic dilatation with hydrocele, elephantiasis of limbs, lymphoedema of genitalia and chyluria.
Lymphatic filariasis affects 120 million persons living in 73 countries, with India accounting for 40% of global infections. A recent estimate has shown that in India, 22 states are endemic and 9 states (AP, Bihar, Gujarat, Kerala, Maharashtra, TN, Orissa, UP and WB) contribute to about 95% of the total burden.
Filarial funiculo-epididymitis may be isolated with remession, or repetitive and progressive. Local pain radiating to the testis or simulating ureteric colic, may be accompanied by systemic symptoms. Palpable cord like swelling may be accompanied by hydrocele. Bacterial superinfection, brings exquisite pain, high grade fever and septic thrombophlebitis.
Prognosis of the funicular filarial attack is variable. Mild cases may involute spontaneously, but more often augur recurrences and chronic lymphedema. The disease frequently simulates malignancy. Bacterial infection and malignancy should be excluded. Filariasis should be treated by surgical decompression or excision of filarial nodules, preserving the testis and the cord. When the disease is recurrent, painful and deforming or complicated by blood vessel involvement, ipsilateral orchidectomy is warranted.
In men, hydrocele is the most common morbidity due to W. bancrofti. In endemic areas, differentiation of filarial from idiopathic hydrocele is difficult. Milky or sediment rich hydrocele fluid suggests a filarial origin. Hydrocele accompanied by nodules in the cord or epididymis, thick fibrous tunica with cholesterol or calcium deposits and tunical calcification, should prompt a diagnosis of filariasis.
Excision of hydrocele sac is the treatment of choice. Aspiration sclerotherapy or management with diethyl carbamazine (DEC) is ineffective.
SCROTAL, PENILE ELEPHANTIASIS AND LYMPH SCROTUM:
For genital elephantiasis, the treatment is excision and reconstruction by full thickness skin graft.
As physiological derangement is uncorrected by such procedures, recurrence is common.
Lymph scrotum is profuse scrotal edema, with blistering and weeping of lymph spontaneously. The moist intercrural area gets easily super-infected causing skin ulcers or systemic sepsis.
Chyluria is characterized by passage of milky urine. It is a state of chronic lympho-urinary reflux via fistulous communication secondary to lymphatic stasis caused by obstruction of lymphatic flow. In endemic areas 10% population may be afflicted by filariasis, but chyluria occurs only in 2% of them.
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