ABSTRACT
OBJECTIVE: To present a case of a patient with a duplicated left ureter presenting preoperatively as unilateral hydrosalpinx, chronic pelvic pain, and recurrent urinary tract infections (UTIs). DESIGN: Case report. SETTING: A large university-affiliated infertility center. PATIENT(S): A 37-year-old woman, para 1, with an 18-year history of recurrent UTIs associated with coitus, and chronic pelvic pain with a unilateral hydrosalpinx. MAIN OUTCOME MEASURE(S): Resolution of recurrent UTIs and left flank pain. RESULT(S): The patient has remained symptom free after laparoscopic resection of the duplicated ureter and portion of the bladder at its point of insertion. CONCLUSION(S): We show a rare case of a duplicated left ureter presenting as chronic pelvic pain and recurrent UTIs, demonstrating the importance of a thorough chronic pelvic pain workup.
Subject(s)
Choristoma/diagnosis , Fallopian Tube Diseases/diagnosis , Fallopian Tubes , Pelvic Pain/diagnosis , Ureter/abnormalities , Ureteral Diseases/diagnosis , Urinary Tract Infections/diagnosis , Adult , Choristoma/complications , Diagnosis, Differential , Fallopian Tubes/pathology , Female , Humans , Pelvic Pain/etiology , Recurrence , Ureteral Diseases/complications , Urinary Tract Infections/pathologyABSTRACT
The effects of edema on urethral dose after interstitial prostate brachytherapy with palladium-103 (103Pd) were studied. Fifty patients underwent a 90-Gy 103Pd implant followed by dosimetric computed tomography (CT). Twenty-one days later, a Foley catheter was reinserted and a dosimetric CT was repeated. The mean reduction in prostate volume between day 0 and day 21 was 16%. Median prostate D90 on day 0 was 89.7 Gy (range 59.5 to 127) and 99.5 Gy (range 62.5 to 130) on day 21. Median prostate V100 was 90% (range 63 to 98%) on day 0 and 96% (range 66 to 99%) on day 21. Median V150 was 61% (range 31 to 85%) on day 0 and 75% (range 39 to 93%) on day 21. Median urethral D50 was 107 Gy (range 57 to 201) on day 0 and 126 Gy (range 64 to 193) on day 21. Regression analysis demonstrated a significant correlation between the decrease in the prostate volume and the increased urethral D50 (r 0.58, p < 0.05). Acute urinary toxicity was 32% grade 0, 38% grade 1, and 30% grade 2. The median urethral D50 increased by a mean of 18% with a correlation coefficient of 0.58 (p < 0.05). Catheterization of the urethra was well tolerated and was of value in better characterizing urethral dose after 103Pd brachytherapy.
