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Urolith masquerading as severe acute radiation toxicity: case report

Daniel Toguri¹, D. Andrew Loblaw², Robert K. Nam³

1 Clinical Clerk, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
2 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
3 Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Address correspondence to Dr. Andrew Loblaw, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada

Canadian Journal of Urology 2010, 17(1), 5040-5043.

Abstract

Introduction: Postoperative radiotherapy after radical prostatectomy has been shown to improve numerous outcomes for selected patients in mature randomized controlled trials. During treatment patients usually experience mild to moderate urinary symptoms, lower gastrointestinal symptoms and tiredness. We describe an unusual case of a patient experiencing severe, culture negative urinary symptoms early in a course of salvage radiotherapy.
Materials and methods: A patient's history was retrospectively derived from a single institution.
Results: A total radiation dosage of 66 Gy in 33 fractions was to be delivered to the prostate bed by intensity modulated radiation therapy. Urinary symptoms consisting of hematuria, dysuria and urination of cellular debris developed very early during the treatment, were not related to infection and were refractory to breaks from radiation therapy. Computed tomography imaging revealed a 3.5 cm diameter urolith in the posterior bladder. Urinary symptoms resolved after surgical management consisting of, cystolitholapaxy with laser cystoscopy.
Conclusions: While rare, urolithiasis should be considered when severe, early, culture negative dysuria develops on radiotherapy for prostate cancer.

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