Urolith masquerading as severe acute radiation toxicity: case report.
BACKGROUND
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.


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.
Clinical Clerk, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
Daniel
D
Toguri
D Andrew
DA
Loblaw
Robert K
RK
Nam
D000208:Acute Disease; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis*; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D016879:Salvage Therapy; D001744:Urinary Bladder Calculi / Q000175:diagnosis*; D014555:Urination Disorders / Q000150:complications / Q000175:diagnosis* / Q000209:etiology