URETHRAL POLYPS IN PREPUBERTAL GIRLS

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.

A Rare Interlabial Mass in a 9-Month-Old Infant: A Case Report and Review of Literature

BACKGROUND

Interlabial masses in infants and children are quite rare. One of their rarest causes is urethral polyp or urethral caruncle. It is a benign fleshy outgrowth at the urethral meatus. Certain etiology is still unknown.

CASE

A healthy 9-month-old female infant presented with a mass protruding from the vulva with no other complaints. Examination with the patient under general anesthesia revealed an interlabial mass appearing as a pedunculated pinkish polyp, originating from the posterior lip of the external urethral meatus. Surgical excision of the mass was done and histopathology confirmed it to be a urethral polyp.

SUMMARY AND CONCLUSION

Urethral polyps are rare in the pediatric age group. Their occurrence in this age group might support a congenital etiology. Surgical resection of polyps allows histopathological examination and a high cure rate with no risk of recurrence.

Ultrasonic manifestation of urethral polyp in a girl: a case report

Urethral polyp, a rare condition, occurs frequently in boys but seldom in young girls. In this report, we describe a case of a six-year-old female patient who experienced dysuria for eight days. Color ultrasound of the patient's urinary system revealed a solid nodule 14×9 mm in size at the opening of the urethra in the trigonal area of the bladder. The nodule was connected to the urethra's posterior wall, and no blood flow signal could be detected. The primary diagnosis was urethral mass. A F7 ureteroscope was used as the cystourethroscope and was inserted into the bladder via the external opening of the urethra. Biopsy forceps were used to remove pathological lesions from the uplifted mucosa and submucosa. The postoperative pathological report was urethral polyp. When a child experiences intermittent urine retention, intermittent hematuria, and intermittent lower urinary tract symptoms, urethral polyp should be considered first.

Role of neurogenic inflammation in local communication in the visceral mucosa

Intense research has focused on the involvement of the nervous system in regard to cellular mechanisms underlying neurogenic inflammation in the pelvic viscera. Evidence supports the neural release of inflammatory factors, trophic factors, and neuropeptides in the initiation of inflammation. However, more recently, non-neuronal cells including epithelia, endothelial, mast cells, and paraneurons are likely important participants in nervous system functions. For example, the urinary bladder urothelial cells are emerging as key elements in the detection and transmission of both physiological and nociceptive stimuli in the lower urinary tract. There is mounting evidence that these cells are involved in sensory mechanisms and can release mediators. Further, localization of afferent nerves next to the urothelium suggests these cells may be targets for transmitters released from bladder nerves and that chemicals released by urothelial cells may alter afferent excitability. Modifications of this type of communication in a number of pathological conditions can result in altered release of epithelial-derived mediators, which can activate local sensory nerves. Taken together, these and other findings highlighted in this review suggest that neurogenic inflammation involves complex anatomical and physiological interactions among a number of cell types in the bladder wall. The specific factors and pathways that mediate inflammatory responses in both acute and chronic conditions are not well understood and need to be further examined. Elucidation of mechanisms impacting on these pathways may provide insights into the pathology of various types of disorders involving the pelvic viscera.

Pathomorphological Analysis and Evaluation of Microcirculation in Polyps of the External Urethral Meatus in Women

Combinations of various factors of polypogenesis determine the formation of a mixed structural phenotype of urethral polyps consisting of heterogeneous changes of the epithelium (hyperplasia, metaplasia, and erosions), inflammatory cell infiltration of the stroma, and dilatation of the venous plexus vessels. Urogenital infections are associated with the predominance of symptoms of inflammation, high serum levels of IL-1β and TNF-α, more extensive areas of inflammatory infiltration and subepithelial microvascular bed, predominance of hyperemic form of microcirculatory disorders. The combination of hyperplastic reactions of the epithelial layer with neoangiogenesis and myofibroblast proliferation in the subepithelial zone confirms the key role of dysregeneratory hyperplasia in the mechanisms of polypogenesis.

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.

Urothelial polyps from anterior urethra in a prepubertal female child: a rare entity

Urothelial polyps arising from the anterior urethra are rarely encountered in the pediatric age group and are even rarer in the females. Scarcely reported in English literature, their exact incidence is not known. They may be asymptomatic for years or present with features of urinary obstruction, mass or "vaginal" bleeding. They are important in the differential diagnosis of interlabial masses in female children. Anterior urethral polyps are benign fibroepithelial lesions. Surgery is indicated for relief of symptoms and differentiation from malignant lesions such as a sarcoma or a papilloma. No recurrences have been reported. We report a case of solitary anterior urethral polyp in an 8-year old girl managed successfully at our centre.