Abstract

Background: Echinococcus granulosus sensu lato (E. granulosus s.l.) is globally distributed and highly prevalent in parts of South America, the Mediterranean, Eastern Europe, the Middle East, Africa, China, and Australia. This systematic review explores the epidemiological and clinical features of urogenital system-cystic echinococcosis (UGS-CE).

Aims: To systematically review and synthesize available evidence on the epidemiological patterns, clinical presentations, diagnostic methods, and treatment approaches for UGS-CE.

Study Design: Systematic review.

Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines and was registered in PROSPERO (CRD42024613418). A comprehensive literature search was conducted in the PubMed, Scopus, and Web of Science databases for articles published between 1990 and 2024. Studies based on individual data were included if the UGS-CE diagnosis was confirmed by imaging or laboratory methods.

Results: After screening 1976 records, 490 studies were finally included to comprise the following 698 UGS-CE cases: 561 (80.4%) involved the urinary system; 110 (15.8%) involved the female genital system; and 27 (3.9%) involved the male genital system. The kidney (478, 68.5%) was the most commonly affected organ, followed by the adrenal gland (64, 9.2%), the ovary (51, 7.3%), and the uterus (24, 3.4%). Radiological imaging, especially ultrasonography, was the primary diagnostic method used, which is often supported by computed tomography (CT). Treatment was mainly surgical and in combination with antiparasitic therapy. Among the 155 patients who underwent surgical treatment, 134 were initially misdiagnosed with either malignant or benign tumors.

Conclusion: Though rare and often non-specific, UGS-CE must be considered in patients with abdominopelvic or flank pain, hydatiduria, urinary symptoms, infertility, or dysmenorrhea, especially in endemic areas. Early detection and appropriate management are crucial to improving the outcomes. A radiological assessment is the primary diagnostic method, with ultrasonography as the most effective, often supported by CT. Treatment is mainly surgical and complemented by antiparasitic therapy to reduce the recurrence/relaps risk.