case_images: PMC10821798_01
case_images: The peripheral blood karyotype
case_images: cureus-0016-00000053068-i01.jpg
case_images: PMC10821798_01_cureus-0016-00000053068-i01.jpg
case_images: FIG1
case_images: Blood tests revealed a total leukocyte count of 5390/muL, a platelet count of 24,000/muL, a hemoglobin level of 12.8 gm%, blood urea nitrogen of 14.6, creatinine at 0.62 (Table 1), and a peripheral blood karyotype of 46XX (Figure 1).
case_images: Changes in OABSS and VAS. OABSS: Overactive Bladder Symptom Score; VAS: Visual Analog Scale; T0: before treatment; T1: one month after treatment; T3: three months after treatment; L1: the first laser therapy; L2: the second laser therapy. Blue Closed Circle: OABSS and Black Closed Square: VAS. The left Y-axis represents the OABSS, while the right Y-axis corresponds to the VAS. In L1 and L2, OABSS and VAS were not measured, so the line between T0 and T1 is dotted. The X-axis represents the passage of time, indicating the time points T0, L1, L2, T1, and T3.
case_images: cureus-0016-00000053068-i02.jpg
case_images: PMC10821798_01_cureus-0016-00000053068-i02.jpg
case_images: FIG2
case_images: T0 to 1 at T1 and 0 at T3. The patient experienced significantly reduced pain during urination, with the Visual Analog Scale (VAS) score improving from 10 at T0 to 1 at T1 and 0 at T3 (Figure 2).
case_images: Changes in urethral thickness on T2-weighted sagittal view. a: before treatment; b: after treatment. Sy: symphysis pubis; UB: bladder; SB: small intestine; R: rectum; S: sacrum; Co: coccyx; TC: transverse colon. Yellow open circle: normal location of the uterus. The yellow line represents the distance between the posterior end of the pubic bone (1) and the posterior end of the urethra (2).
case_images: cureus-0016-00000053068-i03.jpg
case_images: PMC10821798_01_cureus-0016-00000053068-i03.jpg
case_images: FIG3
case_images: Compared to before treatment (Figure 3a), after treatment (Figure 3b), the distance between the posterior end of the pubic bone and the posterior end of the urethra has increased from 15mm to 17mm.
case_images: Changes in signal intensity ratio between the urethra and external sphincter on T2-weighted imaging. a: before treatment; b: after treatment. Ad: adductor muscles; OE: obturator externus muscle; IT: ischial tuberosity; OI: obturator internus muscle; LA: levator ani muscle; Max: gluteus maximus muscle. The yellow circles represent the measurement of MRI values at the same location of the urethra (1) and OE (2).
case_images: cureus-0016-00000053068-i04.jpg
case_images: PMC10821798_01_cureus-0016-00000053068-i04.jpg
case_images: FIG4
case_images: Figure 4 is an MRI in the axial view with fat suppression in T2-weighted imaging (TR 4500 ms, flip angle 140 degrees, TE 118 ms, slice thickness 5 mm, interval 6 mm, FOV 42x47 cm, Matrix 384x384). When examining the ratio of MRI signals at the same location of the pelvic floor muscles and the urethra before treatment (Figure 4a), the ratio is 235/65=3.62. In contrast, after treatment (Figure 4b), the ratio is 114/55=2.07.
case_images: Changes in perineal congestion on heavy T2-weighted imaging. a: before treatment; b: after treatment. Sy: symphysis pubis; UB: bladder; SB: small intestine; R: rectum; S: sacrum; Co: coccyx; TC: transverse colon. Yellow open circle: the venous congestion of blood
case_images: cureus-0016-00000053068-i05.jpg
case_images: PMC10821798_01_cureus-0016-00000053068-i05.jpg
case_images: FIG5
case_images: Figure 5 is an MRI, reconstructed to sagittal 8-mm-thickness images after MIP treatment using 3D data acquisition of T2-weighted coronal images with fat suppression (TR 3000 ms, TE 100 ms, FOV 42 x 47 cm, Matrix 384x256). Compared to before treatment (Figure 5a), after treatment (Figure 5b), there is a decrease in the signal of the veins in the urethra, anterior and posterior to it, and in the perineum.