Porcelain bladder with ascending ureteral calcifications and seminal vesicle calcifications: CT imaging features of advanced urogenital schistosomiasis

Abstract

Urogenital schistosomiasis remains endemic in many regions of Africa and is a well-recognized cause of chronic lower urinary tract pathology. Longstanding infection may lead to bladder wall fibrosis, calcification, ureteral strictures, and hydronephrosis. We report the case of a middle-aged man presenting with chronic lower urinary tract symptoms and intermittent hematuria. Non-contrast computed tomography demonstrated circumferential bladder wall calcification consistent with a porcelain bladder, associated with bilateral ureteral mural calcifications and right-sided ureteropyelocaliceal dilatation. No renal parenchymal abnormalities were identified. This ascending pattern of urinary tract involvement, extending from the bladder toward the ureters with renal sparing, represents a characteristic imaging feature of chronic urogenital schistosomiasis and helps differentiate it from genitourinary tuberculosis, which typically originates in the kidney and progresses downward. Recognition of this imaging distribution is important for accurate diagnosis in endemic regions.