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Case Report
Refractory bladder endometriosis: A difficult disease with a different management
1 Senior Resident, Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
2 Professor, Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
Address correspondence to:
Midhun Mohan
Sakalyam, Vikram Sarabhai Road, Maradu P.O., Kochi 682304, Kerala,
India
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Article ID: 100024Z15MM2022
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Mohan M, Thomas A. Refractory bladder endometriosis: A difficult disease with a different management. J Case Rep Images Urol 2022;7:100024Z15MM2022.ABSTRACT
Introduction: Urinary tract endometriosis is a sporadic disease, and the bladder is the most common site affected, followed by the ureter. First line treatment is usually medical management with hormones. For pervasive and intractable cases of endometriosis, low dose radiation as performed in the present case could be life-saving.
Case Report: A 28-year-old female, known case of primary infertility and endometriosis, presented with cyclical hematuria and dysuria. Cystoscopic evaluation showed a mass in the supratrigonal area, and imaging with MRI showed endometriosis infiltrating the bladder and rectum. Bladder biopsy showed no evidence of malignancy. The disease progressed despite starting medical management with hormone therapy. Since it was refractory to hormone therapy and inoperable, local targeted low dose radiation was explored. Although no similar case was reported in published literature except, radiotherapy to the pelvis was done as a life-saving measure with a dose of 20 Gy in 10 fractions with 15 MV photons delivered to the target, 200 cGy per fraction and 5 fractions a week, in 4 fields [anteroposterior (AP), posteroanterior (PA), left lateral, and right lateral], using 3D conformal radiation therapy (CRT) technique. The patient had an immediate and dramatic response to treatment; a follow-up computed tomography (CT) scan three years later showed complete remission.
Conclusion: Radiotherapy is an effective treatment option that can be tried in medication refractory and surgically inoperable bladder endometriosis.
Keywords: Bladder endometriosis, Gynecological disease, Less invasive treatment, Radiotherapy
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Author Contributions
Midhun Mohan - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Appu Thomas - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Midhun Mohan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
