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Head D, Abdulfattah S, Aghababian A, Fischer K, Mittal S, Weaver J, Godlewski K, Eftekharzadeh S, Saxena S, Long C, Weiss D, Srinivasan A, Shukla A. Unmasking Ureteral Polyps: Insights From a Case Series. Urology 2024:S0090-4295(24)00468-0. [PMID: 38906267 DOI: 10.1016/j.urology.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
Fibroepithelial polyps in the urinary tract are a rare cause of obstructive uropathy with fewer than 130 cases reported in the literature. In our series, we describe polyps that were missed on preoperative imaging and later found in the operating room during pyeloplasty. It is critical for urologists to be aware of polyps as a potential source of obstruction as they can increase the complexity of a reconstruction and, if missed, may result in a failed repair and persistent obstruction. We hypothesize that performing a retrograde pyelogram prior to ureteric reconstruction will facilitate diagnosis prior to surgical repair.
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Affiliation(s)
- Dennis Head
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Suhaib Abdulfattah
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aznive Aghababian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Katherine Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - John Weaver
- Department of Urology, Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH
| | - Karl Godlewski
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | | | - Sonam Saxena
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Dana Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Aseem Shukla
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA.
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Wang X, Zhang Y, Zhang J, Li Z, Han G, Zhang L, Li X, Yang K, Wang B, Zhang P, Huang C, Liu J, Zhu H, Zhou L, Zhang K, Li X. Minimal-invasive ileal ureter replacement for the management of multiple ureteral polyps: the initial experience. Int Urol Nephrol 2024; 56:1919-1926. [PMID: 38200364 DOI: 10.1007/s11255-023-03850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/09/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To present our initial experience in the management of multiple ureteral polyps with robotic or laparoscopic ileal ureter replacement (IUR). METHODS Eight consecutive patients diagnosed with multiple ureteral polyps underwent robotic or laparoscopic IUR between July 2019 and November 2022. Unilateral IUR was performed in 5 patients with polyps in the left (n = 3) or right (n = 2) side, and 3 patients with bilateral multiple polyps underwent bilateral IUR. Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected. RESULTS A cohort of 5 male and 3 female patients (11 ureters) with a mean age of 32.8 ± 11.3 years were included. Among these patients, 5 presented with recurrent flank pain, 1 had hematuria, and 2 were asymptomatic. Four patients experienced prior failed surgical interventions. The mean length of diseased ureter was 11.9 ± 4.7 cm, with more than 10 cm in eight sides. All procedures were performed successfully. The mean operation time was 319 ± 87.6 min with 3 patients who simultaneously underwent intraoperative ureteroscopy. The mean length of ileal graft was 23.8 ± 5.8 cm. During the mean follow-up of 20.4 ± 12.8 months, one major complication, specifically incision infection, and four minor complications, including urinary infection (n = 3) and metabolic acidosis (n = 1), were observed. All patients presented symptom-free, with improved/stabilized hydronephrosis and no signs of restenosis. CONCLUSION Robotic or laparoscopic IUR is a feasible, safe, and effective surgical option for patients with long ureteral defects caused by multiple polyps.
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Affiliation(s)
- Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yiming Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jilong Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
- Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Lianghao Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, No. 29 Xibahenanli St, Chaoyang District, Beijing, 100020, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Jing Liu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, No. 6 Rufuli St, Xicheng District, Beijing, 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Centre, Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
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Tao CP, Cao YS, Mao CK, Peng B. Laparoscopic treatment of pediatric duplicated kidney with ureteral fibroepithelial polyps: A case report. Asian J Surg 2024; 47:1499-1500. [PMID: 38065739 DOI: 10.1016/j.asjsur.2023.11.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Cheng-Pin Tao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yong-Sheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
| | - Chang-Kun Mao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Bo Peng
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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Tao C, Cao Y, Mao C. Analysis of the Therapeutic Efficacy of Laparoscopic Treatment for Fibroepithelial Polyps of the Ureter in Children. J Endourol 2024; 38:219-227. [PMID: 38185850 DOI: 10.1089/end.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The aim of this study is to assess the efficacy and safety of laparoscopic surgery in the treatment of pediatric ureteral fibroepithelial polyp (FEP) patients. Our hypothesis is that laparoscopic surgery can effectively treat FEPs while minimizing patient discomfort and complications. Our research aims to evaluate the clinical outcomes of the surgery, including postoperative symptom relief, improvement in kidney function, and risk of postoperative complications. Methods: The clinical records of 34 patients who underwent ureteral polyp surgery at the Department of Urology at Anhui Provincial Children's Hospital between May 2014 and February 2023 were retrospectively analyzed. All patients underwent laparoscopic surgery. Among the 34 pediatric patients, there were 31 males and 3 females, with 2 on the right side and 32 on the left side. Of these cases, 24 polyps were located at the ureteropelvic junction, while seven were found in the upper segment of the ureter and three in its middle segment. Patients' ages ranged from 4 years and 3 months to 15 years, with a median age of 8 years and 6 months. All children presented with varying degrees of hydronephrosis, and preoperative clinical symptoms included ipsilateral flank or abdominal pain, hematuria, and other discomfort. Preoperative examinations mainly comprised ultrasound, intravenous pyelography, CT, or magnetic resonance urography imaging studies, as well as diuretic renography. All pediatric patients underwent laparoscopic excision of the polyp segment of the ureter, followed by renal pelvis ureteroplasty or ureter-to-ureter anastomosis. Results: All patients underwent surgery without conversion to open surgery. The surgical duration ranged from 72 to 313 minutes, with an average of 179.5 minutes. The average intraoperative blood loss was 14 mL. Postoperatively, one patient experienced leakage at the anastomotic site; however, no other significant complications occurred during or after the procedure. Postoperative histopathology confirmed the presence of FEPs in the ureter for all cases. All patients experienced a favorable postoperative recovery, with hospitalization periods ranging from 3 to 16 days and an average stay of 8.6 days. A Double-J stent was inserted in all patients for a duration of 1 to 2 months after surgery, and upon removal, follow-up color Doppler ultrasound revealed reduced hydronephrosis within 1 to 3 months. Follow-up examinations were conducted at intervals ranging from 3 to 108 months postsurgery, with an average follow-up time of 42.2 months, during which no recurrence of ureteral polyps or symptoms such as pain and hematuria was observed. Conclusions: The findings of this study demonstrate that laparoscopic excision of the polyp segment of the ureter, renal pelvis ureteroplasty, and ureter-to-ureter anastomosis represent safe and effective treatment modalities for pediatric FEPs in the ureters. This technique offers several advantages, including minimal invasiveness, rapid recovery, and definitive therapeutic efficacy, which effectively alleviate clinical symptoms and improve hydronephrosis.
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Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
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Sabat N, Dissanayake M. Siamese twin polyps: exploring the nature and management of the exceptionally rare bilobed colonic polyps. ANZ J Surg 2023; 93:714-715. [PMID: 35852962 DOI: 10.1111/ans.17909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/28/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
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Robot-assisted excision of partially obstructing ureteral fibroepithelial polyp in a child: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Xia W, Chen X, Li B, Chen H, Zhu Z, He Y, Gan Y, Zhang B, Wang K, Li Y, Jiang Z, Long J, Chen Z. Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences. Front Surg 2022; 9:814290. [PMID: 35284473 PMCID: PMC8913589 DOI: 10.3389/fsurg.2022.814290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe purpose of this study was to report our experience in treating multiple ureteral polyps with transabdominal laparoscopic ureteroureterostomy (LAP-UU) with intraoperative retrograde ureteroscopy (RU)-assisted technique.MethodsThe data of 32 patients who underwent transabdominal LAP-UU with the intraoperative RU-assisted technique due to multiple ureteral polyps between January 2011 and March 2021 were reviewed at our institute. After administration of anesthesia, patients were placed in a passive position and underwent a three-port transabdominal laparoscopy with RU. Detailed data were reviewed, such as demographic characteristics, intraoperative outcomes, postoperative data, complications, and pathology reports.ResultsThirty-two patients were diagnosed with multiple ureteral polyps underwent this surgery method at our institution. The mean duration of symptoms at the time of diagnosis was approximately 7.1 months. The mean age of patients was 42.4 years, with men accounting for 68.8% (22/32), lesion of left for 56.3% (18/32), and the upper ureter for 62.5% (20/32). Furthermore, the median length of the polyps was 3.6 cm, the mean operative time was 174.6 min, and the estimated blood loss (EBL) was about 86.8 ml. The mean time to begin a liquid diet and to be out of bed were 1.7 and 2.3 days, respectively. The average length of hospital stay was 6.3 days. The ureteral stent was removed by cystoscope 2–3 months after surgery. Follow-up duration ranged from 3 to 112 months and none of the patients required another surgery for recurrence.ConclusionTransabdominal LAP-UU combined with the intraoperative RU-assisted technique is an effective, safe, and reliable surgical option for patients with multiple ureteral polyps. Further long-term follow-up is recommended.
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Affiliation(s)
- Weiping Xia
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bingsheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Kangning Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zexiang Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jin Long
- Department of Urology, The Second Affiliated Hospital, Guizhou Medical University, Kaili, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zhi Chen
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Yamane H, Nishikawa R, Muraoka K. Ureteral fibroepithelial polyp: A case report. Urol Case Rep 2021; 39:101815. [PMID: 34471606 PMCID: PMC8387746 DOI: 10.1016/j.eucr.2021.101815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
Ureteral fibroepithelial polyps are rare, accounting for approximately 2–6% of all ureteral tumors. They can be diagnosed by ultrasonography, computed tomography, and retrograde pyelography; however, diagnosis can be difficult. Management is by resection of the polyp, and endoscopic resection is the standard treatment. Partial ureteral resection and ureteral reconstruction may be necessary depending on the size and location of the polyp. Imaging follow-ups for approximately a year post-surgery are recommended. This clinical case report aimed to highlight a case of a fibroepithelial ureteral polyp that was managed by endoscopic resection.
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Chu H, Cao Y, Deng Q. Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000243. [DOI: 10.1136/wjps-2020-000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo summarize the diagnosis and treatment experience of children with intermittent hydronephrosis caused by ureteral fibroepithelial polyp (UFP).MethodsFrom 2017 to 2020, cases of hydronephrosis caused by ureteral polyp in Anhui Provincial Children’s Hospital were retrospectively enrolled for investigation. Demographic data, clinical manifestations, operation details, pathology and outcomes were collected from patients’ medical data for analysis.ResultsAll seven cases of UFP were boys, including six cases on the left side of the ureter and one case on the right side, at the median age of 7.1 years (3–14 years), with abdominal intermittent pain as the first symptom. All cases underwent laparoscopic pyeloureteroplasty. All the operations were completed successfully; postoperative pathology indicated the presence of primary UFP. Postoperative follow-ups of 1–30 months showed satisfactory recovery and relief from hydronephrosis.ConclusionsLaparoscopic pyeloureteroplasty or ureteroureterostomy is one of the optimal treatments for ureteral polyp at present. The surgical method should be determined according to the number of polyps, the length and the diameter of the affected ureter, and also the status of renal function of the patients.
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Benign ureteral polyps causing upper urinary tract obstruction. Urol Case Rep 2021; 37:101619. [PMID: 33680856 PMCID: PMC7930583 DOI: 10.1016/j.eucr.2021.101619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Abstract
Ureteral fibroepithelial polyps are benign, mesodermal neoplasms that can cause upper urinary tract obstruction. The preoperative diagnosis of this disease is challenging, but multidetector computed tomography (CT), particularly CT urography in the excretory phase, can be used to detect the features of ureteral polyps. We illustrated a case preoperatively diagnosed as upper ureteral tract obstruction due to ureteral tumor based on clinical presentation and CT imaging. However, the histopathological report revealed ureteral fibroepithelial polyps. Ureteral fibroepithelial polyps should be considered as a rare cause of urinary obstruction when the clinical presentation and imaging findings are atypical for more common etiologies.
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He M, Li N, Zhang W, Ren Z. Preoperative diagnosis, treatment, and outcomes of FEPs of ureters in children: a 13-year retrospective study based on data at a large pediatric medical center. World J Urol 2020; 39:2239-2243. [PMID: 32844353 PMCID: PMC8217005 DOI: 10.1007/s00345-020-03379-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe our experience in handling cases of children with fibroepithelial polyps (FEPs) of ureters. We specifically present preoperative diagnosis approaches, provide a clear definition of this entity and its outcomes following treatment. Method Clinical data of children with FEPs who were consecutively treated at Beijing Children's Hospital from January 2006 to May 2019 were retrospectively analyzed in this study. The clinical data reviewed included diagnostic, intraoperative, and follow-up data. Results Of the 2653 children with surgery for hydronephrosis reviewed, 48 (1.8%) cases of FEPs of the ureters were identified, with a mean age of 109 ± 34.7 months. Among them, males accounted for 95.8%, left side for 81.3%, and proximal ureteral polyps for 97.9%. Notably, 70.8% of patients had only 1 polyp and the median size of the polyps was 2.1 ± 1.8 cm. All patients underwent ultrasound before surgery, which revealed the existence of polyps in 29 (60.4%) children. These polyps were completely resected surgically. The mean follow-up was 82 months (range of 6–153 months) and no cases of recurrences of polyps were seen after surgery during follow-up. The rate of other long-term complications was 9.3%. Conclusions In conclusion, FEPs are one of the important causes of hydronephrosis in children. Ultrasound is effective for preoperative diagnosis achieving higher true positive rates than other diagnostic methods. Although the recurrence rate of polyps and symptoms are low after complete resection in children, long-term follow-up is advocated to the adolescence stage to monitor the incidences of urinary tract infections, ureteropelvic junction obstruction and stone formation. Electronic supplementary material The online version of this article (10.1007/s00345-020-03379-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meng He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China.
| | - Zhentao Ren
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nan Li Shi Lu Street No. 56, Beijing, 100045, China
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Kantar M, Hekimgil M, Harman M, Oral A, Öge Ö, Avanoglu A. Unusual presentation of diffuse large B-cell non-Hodgkin's lymphoma in children: bilateral ureteral involvement. Pediatr Hematol Oncol 2019; 36:504-509. [PMID: 31566047 DOI: 10.1080/08880018.2019.1663325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin's lymphomas (NHL) are common malignant tumors in children and adolescents. Among them diffuse large B-cell lymphomas (DLBCL) are relatively rare as compared to non-cleaved small cell lymphoma (mostly Burkitt's-BL) and lymphoblastic lymphoma (LL). While BL has abdominal or cervical site predilection, LL (mostly T-cell) tends to have mediastinal involvement. However, diffuse large B-cell lymphomas may involve abdomen, peripheral lymph nodes, skin, bone, other rare sites. Ureteral NHLs are extremely rare in children; however, many cases have been reported in adults. In adults the histopathology is usually follicular lymphoma. Only one case of unilateral ureter DLBCL has been reported in an adolescent in the past. Here we report a case of bilateral ureteral DLBCL to highlight the unusual presentation of NHLs and that it should be considered in the differential diagnosis of acute renal insufficiency.
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Affiliation(s)
- Mehmet Kantar
- Department of Pediatrics, Division of Pediatric Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Mine Hekimgil
- Department of Pathology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiodiagnostics, Ege University School of Medicine, Izmir, Turkey
| | - Aylin Oral
- Department of Nuclear Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Ömer Öge
- Urology Unit, Kent Hospital, Izmir, Turkey
| | - Ali Avanoglu
- Department of Pediatric Surgery, Ege University School of Medicine, Izmir, Turkey
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Chaker K. Benign fibroepithelial polyp of the ureter: A case report. Urol Case Rep 2019; 22:15-16. [PMID: 30319938 PMCID: PMC6180234 DOI: 10.1016/j.eucr.2018.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022] Open
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Chaker K, Rhouma SB, Daly KM, Zehani A, Bibi M, Chehida MAB, Sellami A, Nouira Y. Benign fibroepithelial polyp of the ureter: A case report. Urol Case Rep 2018; 22:52-53. [PMID: 30425926 PMCID: PMC6226574 DOI: 10.1016/j.eucr.2018.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kays Chaker
- Departement of Urology La Rabta Hospital, Tunisia
| | | | | | - Alia Zehani
- Department of Anatomy and Pathological Cytology, La Rabta Hospital, Tunisia
| | - Mokhtar Bibi
- Departement of Urology La Rabta Hospital, Tunisia
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15
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16
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Iatrogenic Fibroepithelial Polyps in Children With Hydronephrosis. Urology 2017; 104:172-174. [PMID: 28209548 DOI: 10.1016/j.urology.2017.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/29/2017] [Accepted: 02/05/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To discover the possible factor of the iatrogenic fibroepithelial polyps (FEPs). MATERIALS AND METHODS A retrospective chart review of 28 pediatric patients who have undergone pyeloplasties for ureteropelvic junction obstruction with pathologically proven FEPs was performed from January 2009 to June 2016 at our hospital. Among them, 6 patients without apparent FEPs at the time of the first pyeloplasty were found to have FEPs at the time of reoperation. The medical history and clinical, diagnostic, intraoperative, pathologic, and follow-up data of the 6 patients were reviewed. RESULTS All iatrogenic FEPs were located proximal to the anastomotic stoma. On pathological examination, the size of the FEPs ranged from 1.5 to 3.5 cm. The FEPs were pink, grayish-white, or tan-gray in color and cauliflower-like in shape. Microscopically, they arose from the submucosa and consisted of a layer of normal transitional epithelium covering a fibrovascular stromal core showing sparse vascularity and prominent edema. The mean follow-up period was 47 months (range, 4-82 months). All patients' symptoms disappeared and the function of the affected kidney was preserved after the second pyeloplasty. No patients developed FEP recurrence. CONCLUSION Nephrostomy may associate with iatrogenic FEPs in young children. Iatrogenic FEPs are a specific type of polyp that grows rapidly within a very short time. Pathologically, iatrogenic FEPs are the same as other types of FEPs.
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Dai LN, Chen CD, Lin XK, Wang YB, Xia LG, Liu P, Chen XM, Li ZR. Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases. J Pediatr Urol 2015; 11:257.e1-5. [PMID: 25982337 DOI: 10.1016/j.jpurol.2015.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. OBJECTIVE To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. METHODS Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. RESULTS All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. CONCLUSIONS Ureteral fibroepithelial polyps are rare but rather important as they can cause UPJ obstruction, which often manifests as hydronephrosis. It is most important to confirm the site of ureteral obstruction before surgery as this may have an effect on the surgical management. It is recommended that UFP be successfully managed in children with retroperitoneal laparoscopy.
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Affiliation(s)
- L N Dai
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - C D Chen
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - X K Lin
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Y B Wang
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - L G Xia
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - P Liu
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - X M Chen
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Z R Li
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Ludwig DJ, Buddingh KT, Kums JJM, Kropman RF, Roshani H, Hirdes WH. Treatment and outcome of fibroepithelial ureteral polyps: A systematic literature review. Can Urol Assoc J 2015; 9:E631-7. [PMID: 26425226 DOI: 10.5489/cuaj.2878] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fibroepithelial polyps of the ureter are rare. Cases and small series are reported in the literature. The treatment of choice, outcome and appropriate follow-up regimen remain unclear. METHODS We conducted a systematic literature review of papers reporting fibroepithelial polyps of the ureter in adult patients. Articles published before 1980 were excluded. RESULTS The search yielded 144 papers, of which 68 met the inclusion criteria. A reference scan from the included 68 yielded an additional 7 new articles. In total, our study included 75 articles (68 + 7). A total of 134 patients were described. Most patients had a single lesion (range: 1-10). The median length of the polyp was 4.0 cm (range: 0.4-17.0). The percentage of polyps resected endoscopically increased from 0% before 1985 to 67% after 2005. Two perioperative complications were reported in 72 procedures (2.8%): a deep venous thrombosis and a case of mesenteric lymphadenopathy. Both of these occurred after open surgery. Follow-up data were available for 57 patients. The median follow-up was 12 months (range: 1-180). Four patients (7.0%) developed recurrent complaints: 2 had urinary stones, 1 had a ureteral stricture and 1 had recurrence of the polyp. Three of these events followed endoscopic resection, and occurred within a year after the procedure. CONCLUSION Endoscopic resection of fibroepithelial polyps seems to be safe and effective. It is minimally invasive and should be considered the gold standard where endoscopic expertise is available. We advise follow-up imaging by computed tomographic intravenous urography after 3 months and ultrasound after 1 year to detect late complications.
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Affiliation(s)
- Dina J Ludwig
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Karel T Buddingh
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jan J M Kums
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | - René F Kropman
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hossain Roshani
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Willem H Hirdes
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
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Li R, Lightfoot M, Alsyouf M, Nicolay L, Baldwin DD, Chamberlin DA. Diagnosis and management of ureteral fibroepithelial polyps in children: a new treatment algorithm. J Pediatr Urol 2015; 11:22.e1-6. [PMID: 25218353 DOI: 10.1016/j.jpurol.2014.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Fibroepithelial polyps are benign mesenchymal tumors arising from the urinary tract. With the advent of endoscopy in the pediatric population, more reports of endoscopic diagnosis and treatment have appeared. OBJECTIVE The present study reports experience with the diagnosis and treatment of fibroepithelial polyps of the upper urinary tract in the pediatric population. Incorporating past experience from literature, we propose an algorithm to guide the clinical diagnosis and treatment plan. STUDY DESIGN Four pediatric patients undergoing pyeloplasty for ureteropelvic junction (UPJ) obstruction were diagnosed with ureteral polyps. Their demographics, radiologic, surgical and pathologic information were reviewed. In addition, a comprehensive literature search using the MEDLINE database yielded 37 reports containing 126 cases of ureteral polyps, including 5 series with 57 cases and 9 cases of synchronous bilateral ureteral polyps. RESULTS Of 123 pediatric patients undergoing pyeloplasty from 2008 to 2013, four (3.3%) were found to have fibroepithelial polyps of the upper urinary tract. All patients were male and the mean age of presentation was 12 years. Ureteral polyps predominantly occurred unilaterally in the left ureter (75%) and one case of bilateral ureteral polyps was encountered. Along with three other recent case series [1-3], the combined incidence of ureteral polyps in patients undergoing evaluation for ureteral obstruction was 5.2%. Intraoperative retrograde pyelogram was used to identify filling defects in 4 of 5 affected ureters (see Figure). Ureterorenoscopy was performed in all three patients with filling defects for polyp mapping along the ureter and evaluation of the macroscopic polyp appearance. Based on ureteroscopic findings, Holmium laser polypectomy was performed in two patients with single, pedunculated polyps. Anderson-Hynes dismembered pyeloplasty was performed in three patients with broad based, multilobulated polyps too large for endoscopic treatment and in one patient for undiagnosed polyp prior to pyeloplasty. DISCUSSION The present study finds that the 5.2% combined incidence of ureteral polyps in contemporary reports may be higher than previously described [4]. Retrograde pyelogram was an effective tool in diagnosing ureteral polyp and ureteroscopy can be employed if ureteral polyps are suspected for both diagnostic and therapeutic purposes. Although clinical experience is limited, endoscopic laser treatment seems to be effective for the single, pedunculated ureteral polyps, while dismembered pyeloplasty is required for the broad based, multilobulated polyps. The study was limited by the rarity of ureteral polyps. Future multi-institutional collaborative studies are required to validate the diagnostic and treatment algorithm proposed. CONCLUSION Ureteral polyps cause approximately 5% of UPJ obstruction in the pediatric population. Diagnosis can be made in certain cases by intraoperative retrograde pyelogram. If a filling defect is encountered, ureteroscopy is indicated for polyp mapping. The treatment modality is dictated by the endoscopic appearance of the ureteral polyp.
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Affiliation(s)
- R Li
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - M Lightfoot
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - M Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - L Nicolay
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - D D Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - D A Chamberlin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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A giant pedunculated urothelial polyp mimicking bladder mass in a child: a rare case. Case Rep Pediatr 2014; 2014:935850. [PMID: 24716071 PMCID: PMC3971890 DOI: 10.1155/2014/935850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/18/2014] [Indexed: 11/18/2022] Open
Abstract
Ureteral fibroepithelial polyps are rarely seen benign tumors with mesodermal origin. These polyps can involve kidney, pelvis, ureter, bladder, and urethra. The most common symptoms are hematuria and flank pain. The choice of treatment is either endoscopic or surgical resection of polyp by sparing kidney. Here, we presented a pediatric case with giant, fibroepithelial polyp that mimics bladder tumor, originating from middle segment of the ureter.
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Shive ML, Baskin LS, Harris CR, Bonham M, MacKenzie JD. Ureteral fibroepithelial polyp causing urinary obstruction. J Radiol Case Rep 2013; 6:23-8. [PMID: 23365709 DOI: 10.3941/jrcr.v6i7.1076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ureteral polyps are rare causes of ureteropelvic junction (UPJ) obstruction, particularly in children. We report a nine year-old boy with UPJ obstruction initially suggestive of an obstructive urinary stone. CT showed intraureteral calcification at the UPJ and hydronephrosis. A retrograde pyelogram showed narrowing at the UPJ and partial obstruction that was found to be a ureteral polyp. This case illustrates a rare cause of UPJ obstruction that should be considered when the imaging findings and presentation are atypical for more common etiologies of ureteral obstruction.
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Affiliation(s)
- Melissa L Shive
- UCSF School of Medicine, UCSF Medical Center, San Francisco, CA, USA
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22
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Wang XM, Jia LQ, Wang Y, Wang N. Utilizing ultrasonography in the diagnosis of pediatric fibroepithelial polyps causing ureteropelvic junction obstruction. Pediatr Radiol 2012; 42:1107-11. [PMID: 22653534 DOI: 10.1007/s00247-012-2404-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 03/14/2012] [Accepted: 03/20/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fibroepithelial polyps are a rare cause of ureteropelvic junction (UPJ) obstruction in children. Preoperative US diagnosis of fibroepithelial polyps is infrequently reported, with intravenous pylogram and retrograde pyelography being most commonly used for diagnosis. OBJECTIVE To recommend the most accurate process for diagnosing this disease in children by assessing a modified ultrasonographic procedure for the diagnosis of fibroepithelial polyps. MATERIALS AND METHODS A retrospective review of US and IVP imaging studies performed in surgically and histologically confirmed cases of fibroepithelial polyps in children. Each child was asked to drink as much water as possible 30 min before the US testing. For US, the renal pelvis, UPJ and the proximal ureter were inspected for an echogenic mass resulting in hydronephrosis. For IVP studies, abdominal plain films were performed at 7, 15 and 30 min following contrast injection. RESULTS Thirty-five children, 34 boys and 1 girl, had confirmed fibroepithelial polyps. The children ranged in age from 3 to 14 years (mean age 9 years). Clinical presentation included intermittent vague abdominal pain (100%) and/or hematuria (9.7%) for a period ranging from 1 month to 5 years. Of the 35 children (37 polyps), 21 (23 polyps) were correctly diagnosed preoperatively with US, establishing a 62.2% (23/37) US accuracy rate. Twenty polyps were seen on the left, three on the right and two children had bilateral polyps. The masses were all mildly echogenic with defined edges. Eight children (9 polyps) had an IVP consistent with fibroepithelial polyps giving IVP an accuracy rate of 24.3% (9/37). CONCLUSION US is an effective screening tool for identifying fibroepithelial polyps causing UPJ obstruction in children.
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Affiliation(s)
- Xiao Man Wang
- National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Department of Ultrasound, Beijing Children's Hospital, Beijing, China 100045
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23
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Abstract
A 11-year-old boy showed gross hematuria and left flank pain. Ultrasonography and CT revealed left hydroureteronephrosis, and he was referred to us for the further evaluation. MRI revealed left hydroureteronephrosis with filling defect at the distal end of the dilated ureter suggesting ureteral polyp. Open surgery was performed with the diagnosis of mid-ureteral obstruction. In the operative findings, multiple stalks of ureteral polyps arose from the entire ureteral wall over 5 cm in length at the site of ureteral obstruction. Mid-ureter with polyps was completely resected, and end-to-end anastomosis was performed. The pathological diagnosis was fibroepithelial polyp of the ureter.
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Ji YH, Cheon SH, Lee H, Moon KH, Choi HJ, Kim YM, Park S, Park S. Giant ureteral polyps causing proximal ureter obstruction: emphasis on the surgical method and ureteroscopy. J Pediatr Surg 2011; 46:e11-5. [PMID: 22075365 DOI: 10.1016/j.jpedsurg.2011.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 06/06/2011] [Accepted: 06/27/2011] [Indexed: 10/15/2022]
Abstract
We describe here the case of a 13-year-old boy who had right flank pain for 3 months. An intravenous pyelogram showed filling defects in the right upper part of the ureter as well as hydronephrosis. Because the diseased part of the ureter was about 5 cm in length and we wished to avoid short ureter after surgery, we performed a minimal segmental resection of the ureter including the entire stalk. Perioperative ureteroscopic examination showed another polyp 3 cm below the primary polyp, which was also removed. End-to-end ureteral anastomosis was performed without mobilization of the kidney. Frozen and formal microscopic examination showed that these polyps were fibroepithelial.
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Affiliation(s)
- Young Hwan Ji
- Department of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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Kojima Y, Lambert SM, Steixner BL, Laryngakis N, Casale P. Multiple metachronous fibroepithelial polyps in children. J Urol 2011; 185:1053-7. [PMID: 21256525 DOI: 10.1016/j.juro.2010.10.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We present our experience with a new phenotype of fibroepithelial polyps recurring in the urinary tract in children after robotic or laparoscopic pyeloplasty, and discuss the most appropriate treatment for these multiple metachronous neoplasms. MATERIALS AND METHODS At our institution 14 children had fibroepithelial polyps as the cause of ureteropelvic junction obstruction at pyeloplasty. Of the patients 12 had at least 1 additional polyp in the ureter, necessitating concomitant ureteroscopy at either robotic or laparoscopic pyeloplasty. Of these 12 patients 9 had followup of at least 1 year. RESULTS In 6 patients with at least 1 year of followup neoplasms were seen on retrograde pyelography and ureteroscopy that were not present on ureteroscopy at pyeloplasty. At 6 months after stent removal following the first recurrence 2 patients (33%) showed a second recurrence on imaging at a different location in the upper tract requiring laser ablation. One of these patients had a third recurrence that required further intervention before all were disease-free. No major intraoperative or preoperative complications developed. CONCLUSIONS We should always consider the possibility of recurrent fibroepithelial polyps in children with ureteropelvic junction obstruction, and recommend routine retrograde pyelography and ureteroscopy at stent removal after laparoscopic or robotic pyeloplasty. Although ureteroscopic management seems to be the most appropriate modality in children with multiple metachronous fibroepithelial polyps, larger studies are needed.
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Affiliation(s)
- Yoshiyuki Kojima
- Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Ammor A, Chamond C, Bargy F, Beaudoin S. [Fibroepithelial polyp of the ureter in a child. A case report]. Prog Urol 2010; 21:291-5. [PMID: 21482406 DOI: 10.1016/j.purol.2010.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 04/22/2010] [Accepted: 05/09/2010] [Indexed: 11/26/2022]
Abstract
Fibroepithelial polyp of the ureter is benign tumor of mesodermal origin that rarely occurs in children. The most common presenting symptoms are hematuria and flank pain by obstruction of the urinary tract. The etiology of this tumor is not clear. It occurs more frequently in boys and often arises in the proximal ureter and the ureteropelvic junction. The preoperative diagnosis is difficult. We present the case of a 10-year-old boy who had recurrent episodes in the left flank owing to polyps of the lumbar ureter of which the fibroepithelial nature was confirmed by the pathological examination of the surgical specimen. We discuss the clinical presentations, imaging, histological features and treatment options of this unusual tumor through a review of the literature.
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Affiliation(s)
- A Ammor
- Service de chirurgie viscérale pédiatrique, hôpital Saint-Vincent-De-Paul, 75014 Paris, France.
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Kanamori Y, Iwanaka T, Sugiyama M, Nakahara S, Kawashima H, Hatanaka A, Komura M, Takazawa Y. Antenatally diagnosed, intermittently worsened hydronephrosis caused by a ureteral polyp. Pediatr Int 2010; 52:e11-3. [PMID: 20158636 DOI: 10.1111/j.1442-200x.2009.02986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yutaka Kanamori
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan.
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Kara C, Reşorlu B, Oğuz U, Ünsal A. Incidentally detected ureteral fibroepithelial polyps in children: is endoscopic treatment of them really necessary? Int Urol Nephrol 2009; 42:1-5. [DOI: 10.1007/s11255-009-9567-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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