Urinary bilharziasis is a parasitic infection responsible for vesical, urethral and renal lesions. The authors demonstrate the importance of ambulatory echography on a large scale and describe various echographic lesions. Vesical attacks occurred in 27% of the wall irregularity, 44% of the masses and polyps. Pyelic and urethral abnormalities occurred in 16.6% and 29.9% of cases respectively at the baseline in 1991. These prevalence rates decreased after seven years, in 1998. The authors discuss the utility of chemotherapy with praziquantel and the necessity of a periodical mass treatment in the areas with high bilharziasis endemicity in Mali.