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.

[Ureteral resection of ureteral inflammatory polyp associated with lithiasis]

We report on a fibroepithelial polyp case with inflammatory characteristics located in the pelvian ureter, and related with an ureteral calculus, which was treated in a conservative way with ureteroscopic resection, after the pincer extraction of the stone. Our team found two fibroepithelial polyp cases in the bibliography reviewed treated with ureteroscopic resection. We consider that the polyp's reactive inflammatory nature is due to the urothelial chronic irritation caused by the calculus.

Renal dysplasia and benign ureteropelvic polyps associated with hydronephrosis in a foal

A 4-month-old male Trakehner foal with a history of hematuria, poor growth, and abnormal hair was found to have unilateral hydronephrosis and hydroureter, as determined by ultrasonography and surgical exploration. Nephrectomy and ureterectomy were performed as treatment. Gross examination of the ureter and kidney revealed renal pelvic and ureteral polyps causing obstruction and subsequent hydronephrosis. The histologic features were consistent with renal dysplasia. The polyps and renal dysplasia were likely to be congenital, but the etiopathogenesis is not known. The finding that urinary outflow obstruction can disrupt nephrogenesis and lead to renal dysplasia supports the view that the polyps developed, blocked urine flow, and caused the hydronephrosis and renal dysplasia in the foal.

An unusual association: fibroepithelial polyp and contralateral nephrolithiasis in a child

A 12-year-old boy presented with fever and flank pain bilaterally. Intravenous pyelogram revealed multiple stones and hydronephrosis in the right kidney and an obstructive filling defect at the left upper ureter. Exploration of the left ureter revealed a fibroepithelial polyp. The presented case was an example of the unreported association between fibroepithelial polyp and contralateral nephrolithiasis.

[2 unusual cases of fibrous polyp of the upper urinary tract (reported occasionally)]

Two rare cases (occasional reports) of fibrous polyp of the ureter and kidney pelvis are described. The symptomatology not significant, and the surgical diagnosis and surgical treatment of these lesions is discussed. The ureterorenoscopy is suggested in the follow-up of these neoformation, but when possible the diagnosis and a correct therapeutic approach is recommended.

Use of ultrasonohysterography for triage of perimenopausal patients with unexplained uterine bleeding

OBJECTIVE

Concerns about pathologic anatomy in perimenopausal women with irregular vaginal bleeding have made invasive diagnostic procedures commonplace. This study evaluated the use of fluid instillation to enhance vaginal probe ultrasonographic examination of the endometrium in such patients.

STUDY DESIGN

This was a prospective study of 21 women between 40 and 52 years old with irregular vaginal bleeding. On day 4 to 6 of the menstrual cycle a 5.3F Soules intrauterine insemination catheter (Cook ObGyn, Spencer, Ind.) was inserted, and under direct ultrasonographic examination sterile saline solution was slowly infused. If present, any polyp or submucous myoma was noted and the endometrial thickness surrounding the fluid was measured. Invasive endometrial sampling was then carried out.

RESULTS

Of the 21 patients, 8 had obvious polypoid lesions and underwent triage for operative hysteroscopic removal. The pathology report confirmed benign polyps in all 8. Three patients had submucous myomas. Two had wire loop resectoscopic excision. The third, with a submucous myoma that extended to the serosal edge of the uterus, received expectant management. Nine patients had no obvious anatomic lesion and endometrial thickness of < or = 4 mm. Biopsy in all 9 of these patients revealed early proliferative endometrium. One patient had endometrial thickness of 8 mm; fractional curettage with hysterectomy revealed simple hyperplasia without atypia.

CONCLUSIONS

Endometrial fluid instillation to enhance vaginal ultrasonography in perimenopausal women can reliably distinguish between patients with minimal tissue whose bleeding may be of anovulatory origin and best treated with hormonal therapy and those patients with significant amounts and type of tissue in need of formal curettage. Furthermore, polyps may be distinguished from submucous myomas, which allows appropriate preoperative triage for operative hysteroscopy when indicated and eliminates the need for diagnostic hysteroscopy.

[Hysteroscopy versus hysterosalpingography in diagnosis of sterility and infertility]

In a prospective study of 68 infertile patients the findings of hysterosalpingography and hysteroscopy have been compared. Hysterosalpingography showed in 3 cases false-negative results and in 10 cases false-positive results. Hysterosalpingography is especially limited for diagnostics of intrauterine adhesions. Hysteroscopy should be a necessary component of diagnostics of sterility, also in case of normal hysterosalpingographical findings.

[Ureteral stenosis caused by benign polyp. A new case]

Congenital ureteral stricture may infrequently be associated with polyps which further exacerbate this obstructive condition. The polyps may grow and cause symptoms in the elderly patients. A recent case is described and the literature reviewed.

Hydronephrosis due to fibroepithelial ureteral polyp in a child

The case of a 5-year-old girl, complaining of left abdominal and flank pain, is reported. The excretory urogram and retrograde pyelography showed an obstruction located at the left upper ureter with hydronephrosis. Exploration revealed a small ureteral polyp obstructing the lumen. The polyp along with the short segment of the ureter was resected. Diagnostic and therapeutic considerations are discussed.

Hysteroscopic findings in patients with a cervical polyp

OBJECTIVE

Our objective was to determine the presence of intrauterine lesions in patients with a cervical polyp.

STUDY DESIGN

We performed a retrospective analysis to determine the influence of hormonal treatment and age on 165 patients with a cervical polyp and bleeding on admission. All 165 patients underwent a diagnostic hysteroscopy to rule out intrauterine lesions, including polyps, fibroids, hyperplasia, and adenocarcinoma.

RESULTS

Endometrial polyps were found in up to 26.7% of patients who had a cervical polyp. In patients undergoing a combined pill treatment this incidence was much lower (8.3%). Menopausal patients had a 56.8% incidence of cervix-related endometrial polyps, and hormone replacement therapy did not significantly increase (45.7% vs 28.6%) the incidence of coexisting polyps. All cervical polyps present during tamoxifen treatment were associated with endometrial polyps. Abnormal vaginal bleeding was of no clinical significance in excluding concomitant endometrial polyps.

CONCLUSIONS

All menopausal patients with a cervical polyp could benefit from a diagnostic hysteroscopy. Premenopausal patients receiving a combined pill treatment are the least likely to have coexistent endometrial polyps.

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.

Osteoma of the external auditory meatus presenting as an aural polyp

Isolated osteomata of the external auditory canal are benign and often symptomless lesions, and are distinct from the much commoner exostoses. A case is reported in which an osteoma presented as a recurrent 'aural polyp' due to a fibroepithelial polypoid reaction in the overlying skin. The polyp and the osteoma were excised surgically. We believe this to be the first reported case to present in this manner.

Histological findings in a falloposcopically retrieved isthmic plug causing reversible proximal tubal obstruction

We present the case of a 33-year-old woman with a 10 year history of infertility. Transvaginal falloposcopy revealed a proximal tubal occlusion (PTO) on the right due to a tissue plug. The plug was removed during dilatation of the tubal lumen. After the procedure patency for dye was restored. Histological and immunohistochemical findings--for the first time, to the best of our knowledge, performed in a falloposcopically retrieved plug--revealed the diagnosis of an inflammatory polyp arising from the tubal mucosa with focal calcifications. Local obstructive inflammatory residues of a previously treated tubal endometriosis, which was accompanied by features of salpingitis isthmica nodosa, are considered the most likely cause for this condition. Other possible aetiological factors responsible for PTO are discussed.

[Polyp of the pyeloureteral junction as the cause of transient obstruction of urine outflow from the kidney]

A 12-year-old boy is presented with a polyp of the pyeloureteral junction causing transient obstruction in the upper urinary tract. The aetiology, pathogenesis, diagnosis and treatment of this rare benign neoplasm are discussed.

An analysis-by-synthesis approach to the estimation of vocal cord polyp features

This paper deals with a new noninvasive method of estimating vocal cord polyp features through hoarse-voice analysis. A noteworthy feature of this method is that it enables us not only to discriminate hoarse voices caused by pathological vocal cords with a single golf-ball-like polyp from normal voices, but also to estimate polyp features such as the mass and dimension of polyp through the use of a novel model of pathological vocal cords which has been devised to simulate the subtle movement of the vocal cords. A synthetic hoarse voice produced with a hoarse-voice synthesizer is compared with a natural hoarse voice caused by the vocal cord polyp in terms of a distance measure and the polyp features are estimated by minimizing the distance measure. Some estimates of polyp dimension that have been obtained by applying this procedure to hoarse voices are found to compare favorably with actual polyp dimensions, demonstrating that the procedure is effective for estimating the features of golf-ball-like vocal cord polyps.