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, an algorithm to guide clinical diagnosis and treatment plans is proposed.
MATERIAL AND METHODS: Four pediatric patients undergoing pyeloplasty for ureteropelvic junction obstruction (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 the 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 (75.0%) 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 four of the five affected ureters. 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 that were too large for endoscopic treatment, and in one patient for undiagnosed polyp prior to pyeloplasty.
CONCLUSION: Ureteral polyps cause approximately 5.0% 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.
Written by:
Li R, Lightfoot M, Alsyouf M, Nicolay L, Baldwin DD, Chamberlin DA. Are you the author?
Department of Urology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA. rli@llu.edu; mlightfoot@llu.edu; malsyouf@llu.edu; linicolay@llu.edu; dbaldwin@llu.edu; dchamberlin@llu.edu
Reference: J Pediatr Urol. 2014 Aug 28. pii: S1477-5131(14)00235-6.
doi: 10.1016/j.jpurol.2014.08.004
PubMed Abstract
PMID: 25218353