Publication

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.