Congenital posterior urethral polyps

Posterior urethral polyp in a male child: a rare case report

Urethral polyps are one of the rare deformities of the urethra. In most cases, the urethral polyps would not be considered in the differential diagnosis process by a huge number of physicians, mainly owing to the rarity of documented cases in the medical literature and because of the wide variety of unspecified symptoms the urethral polyp might demonstrate. Urethral polyps are more common in males than in females, and they are usually diagnosed at an early age. Treatment options include transurethral resection, endoscopic suprapubic approach and open surgery. The disease prognosis is excellent as it does not usually recur after being completely removed and the risk of malignant transformation is very low. We are going to report a case of a 3-month-old boy who presented with bilateral vesicoureteral reflux and hydronephrosis, which revealed the presence of a large posterior urethral polyp.

Verumontanum Polyp in an Adult Man: Diagnosis by Ultrasonography

The fibroepithelial polyp of the urethra is rare in adults. Hematuria and obstructive urinary symptoms are the most common findings. The investigation of these polyps usually includes imaging exams (voiding cystourethrography and ultrasonography) and urinary endoscopy. However, the diagnosis is primarily established by pathology. Ultrasonography can aid in diagnosis, as it can identify a polypoid lesion that can extend to the bladder neck, and cystourethroscopy allows the direct visualization of the lesion. We report this case of a polyp of the prostatic urethra in an adult male using prospective real-time sonographic diagnosis.

Management of lower urinary tract fibroepithelial polyps in children

INTRODUCTION

Fibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date.

OBJECTIVE

The aim of this study was to address the experience of FEP management in children.

STUDY DESIGN

A retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed.

RESULTS

A total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1-48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1-10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1-34) months.

DISCUSSION

The main limitation of our study is the retrospective design, although it is the largest one for this pathology.

CONCLUSION

This series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences.

LEVEL OF EVIDENCE

Level V.

Congenital urethral polyps in girls: as a differential diagnosis of interlabial masses

STUDY OBJECTIVE

To present the clinical appearance, differential diagnosis, long-term follow-up, and the surgical result of single-center experience with female urethral polyps presenting as an interlabial mass, and to report the common causes of interlabial masses in infants.

DESIGN

All 12 girls who presented with an interlabial mass and intermittent bleeding have been included in this study; however, the benign urethral polyps are discussed in detail and are the subject of this study.

SETTING

All patients were referred to our national referral pediatric urology center with initial impression of vaginal bleeding; however, rhabdomyosarcoma of bladder and urethra (n = 2) or vagina (n = 3) and urethral polyp (n = 7) was the final diagnosis.

PARTICIPANTS

The records of 12 girls who presented with external genitalia bleeding were retrospectively reviewed. Among them, 7 had fibroepithelial polyps and underwent initial polypectomy between 2001 and 2011with mean age of 21.5 months (range: 1-90 mo). All girls underwent endoscopic surgical removal of polyps.

MAIN OUTCOME MEASURES

No postoperative polyp recurrence was observed following endoscopic polyp resection.

RESULTS

The postoperative period was uneventful except in 1 girl who had immediate postoperative urethral bleeding which stopped spontaneously. There was no major complication or polyp recurrence after operation during the long-term follow-up.

CONCLUSIONS

The interlabial mass must be considered as a urethral polyp and should be differentiated from the vaginal rhabdomyosarcoma with protrusion of vaginal tumor from the vaginal outlet or other benign lesions. Physical examination in frog legged position or examination under anesthesia with urethrocystoscopy may confirm the final diagnosis.

Recurrent urethral fibroepithelial polyps in a golden retriever

A 2 yr old castrated male golden retriever was referred multiple times over a period of 7.5 yr for stranguria, pollakiuria, urinary incontinence and urinary outflow obstructions due to urethral polyps. Diagnostic imaging modalities used to identify polyps included abdominal ultrasound, excretory urography, double-contrast retrograde urethrocystograms, and urethrocystoscopy, which revealed multiple filling defects within the proximal and prostatic urethra. Multiple cystotomies and endourologic procedures were performed to remove the multiple fibroepithelial polyps within the proximal and prostatic urethra. Urinary incontinence resulted from treatments, but did respond to phenylpropanolamine. Medical treatment consisted of a nonsteroidal anti-inflammatory drug, which appeared to decrease the recurrence of the polyps over time. Urethral polyps are an uncommon cause of urinary outflow obstruction and do not usually recur after removal. This case illustrates an uncommon clinical presentation and the difficulties encountered in treatment over an expanded time frame.

Congenital urethral polyps in children: report of 18 patients and review of literature

BACKGROUND/PURPOSE

To evaluate the presentation, diagnosis and management of congenital urethral polyps (CUP) in children and to report the results of the endoscopic resection of polyp with long-term follow-up.

METHODS

Between April 1995 to March 2010, 18 children (14 boys, 4 girls) with CUP were treated. The most common presentation was urinary outflow obstruction/retention, hematuria or protruding polyp from the urethra meatus in girls. Six patients presented with vesicoureteral reflux (VUR). All children (except one) underwent a transurethral resection of the CUP.

RESULTS

Following the endoscopic resection of the polyps, there was no polyp recurrence, and all patients became symptom-free. The children exhibited no reflux, urinary retention, hematuria or urinary tract infection (UTI) following endoscopic management. Abnormal uroflowmetry patterns returned to normal following the resection of the polyp for one year after the operation.

CONCLUSIONS

Urethral polyps must be considered in every child with history of triad of recurrent intermittent urinary retention, hematuria and lower urinary tract symptoms. The cure can be achieved in all cases by an endoscopic approach. This type of tumor is always benign and very rarely recurs, unless the pedicle stalk is not resected. The endoscopic management of reflux is unnecessary in this group of patients due to their natural history of secondary reflux.

Urethral polyp in asymptomatic male infant with prenatal hydronephrosis

Congenital posterior urethral polyps are rare, benign lesions of the posterior urethra. We report a 1-day-old newborn boy with a solitary fibroepithelial posterior urethral polyp who presented with a history of prenatal mild hydronephrosis, subsequently associated with bladder wall thickening on ultrasonography.

Fibroepithelial polyp of the urethra

The fibroepithelial polyp of the urethra is rare in adults. Hematuria and obstructive urinary symptoms are the most common findings. The treatment of choice is endoscopic resection and the prognosis for these lesions is excellent. There is no previous report on recurrence. We describe 2 new cases, with 1 of them presenting recurrence following surgical resection.

[Fibroepithelial polyp of the urethra in an adult]

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

Genitourinary polyps in children

OBJECTIVES

This study was undertaken to review the presenting complaints, diagnostic evaluation, treatment, and natural history of children with genitourinary polyps seen at the Mayo Clinic during the past 35 years.

METHODS

We retrospectively reviewed the charts of all children less than 16 years of age with symptomatic genitourinary polyps who were seen at the Mayo Clinic between 1957 and 1992. The age of each patient, clinical presentation, anatomic location of the polyp, diagnostic evaluation, and treatment were reviewed. Long-term follow-up data, including complications, were recorded, and the literature was reviewed.

RESULTS

The most common presenting symptoms were hematuria in 9 patients, (gross 7, microscopic 2) and urinary tract obstruction in 9 patients (upper tract 3, lower tract 6). Four children had ureteral polyps. Excretory urography showed hydronephrosis and filling defects in 3 patients and a filling defect without hydronephrosis in 1 child. Two patients underwent segmental ureterectomy, 1 had open excision of the polyp, and 1 had ureteroscopic excision. Urethral polyps were identified in 12 children, most often as a filling defect of the posterior urethra on voiding cystourethrography (5 patients) or during cystourethroscopy (7 patients). All 12 patients were managed successfully by transurethral resection.

CONCLUSIONS

Genitourinary polyps in children require a high degree of alertness and can be diagnosed with excretory urography, with voiding cystourethrography, or endoscopically. The biologic activity of these polyps is uniformly benign, and there have been no recurrences following complete excision.

Benign urethral polyps

Ten male patients presented between 1985 and 1991 with benign urethral polyps. This lesion is believed to represent a developmental error in the invagination process of the submucous glandular material of the inner zone of the prostate. The clinicopathological features of the condition are discussed and the literature is reviewed.

Haemangiomatous polyp of the posterior urethra in a boy

Urethral haemangiomas are rare and usually involve the entire urethra or are localized to the anterior urethra. Posterior urethral polyps are uncommon. A posterior urethral polyp was removed from a 3-year-old boy which proved to be haemangioma. In the histological classification of posterior urethral polyps, haemangioma should therefore be included.