Fibroepithelial polyp of the verumontanum: a case report and review of the literature

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 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.

Capillary haemangioma of verumontanum: case report and review of the literature

A case of 24-year-old male patient with persisting microscopic haematuria is described. The endoscopic diagnosis revealed polyp lesion protruding from the origin of verumontanum. The histopathologic examination showed capillary haemangioma with fibroepitel component containing no prostatic glandular structure. The literature was reviewed, the histogenesis and nomenclature was discussed.

Urethral polyp in neonate: a rare occurrence

Polyps of urethra as well as those in an anterior urethra in a male neonate are a rare abnormality, hence this publication. They usually present as either obstructive urinary symptoms in males or as an intralabial mass in females (Raviv G, Leibovitch I, Hanani J, et al., Hematuria and voiding disorders in children caused by congenital urethral polyps: principals of diagnosis and management. Eur Urol 1993;23:382.

[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.

Fibroepithelial polyp of the verumontanum. A case report and literature review

A case of fibroepithelial polyp of the verumontanum in a 20-year-old male is presented. The endoscopic examination revealed polypoid lesion protruding from the verumontanum, and transurethral resection of the tumour was performed. The histopathological diagnosis was fibroepithelial polyp, containing no prostatic glandular structures. As the nomenclature of the lesions is widely varying, we tried to classify polypoid or papillary lesions of the prostatic urethra by a literature review.

The spectrum of urinary tract fibroepithelial polyps in children

A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In children less than 18 years old only 12 cases of upper tract polyps have been reported. We report 2 additional pediatric cases of upper tract fibroepithelial polyps and a rare case of a fibroepithelial polyp in the bladder. At 2 to 7-year followup there has been no recurrence or further development of the polyps. A benign natural history and conservative therapy should be emphasized when fibroepithelial polyps of the upper or lower urinary tracts are encountered in children.