Laparoscopic Approach to a Rare Cause of Ureteropelvic Junction Obstruction in a Child: Ureteral Polyp

Minimally Invasive Surgical Therapies for Ureteral Polyps: A Systematic Review

Background: Ureteral polyps are rare benign ureteral tumor. No guideline recommends that open or minimally invasive surgery is best for treating ureteral polyps. This article aims to provide a comprehensive review of the minimally invasive techniques currently available for treating ureteral polyps. Materials and Methods: We performed a comprehensive search of articles published in PubMed, using the keywords "ureteral" and "polyp," or "polyps." Results: A total of 275 studies were obtained from the literature search but 96 articles were excluded. Conclusions: Several minimally invasive approaches were developed with the advancement of medical technology, including endoscopic, laparoscopic, and robotic approaches; however, the best surgical technique was yet to be decided. Due to the advantages and disadvantages of these approaches, the best surgical approach should be tailored to each patient's needs and the surgeon's preferences and experience.

Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children

Objective

To summarize the diagnosis and treatment experience of children with intermittent hydronephrosis caused by ureteral fibroepithelial polyp (UFP).

Methods

From 2017 to 2020, cases of hydronephrosis caused by ureteral polyp in Anhui Provincial Children’s Hospital were retrospectively enrolled for investigation. Demographic data, clinical manifestations, operation details, pathology and outcomes were collected from patients’ medical data for analysis.

Results

All seven cases of UFP were boys, including six cases on the left side of the ureter and one case on the right side, at the median age of 7.1 years (3–14 years), with abdominal intermittent pain as the first symptom. All cases underwent laparoscopic pyeloureteroplasty. All the operations were completed successfully; postoperative pathology indicated the presence of primary UFP. Postoperative follow-ups of 1–30 months showed satisfactory recovery and relief from hydronephrosis.

Conclusions

Laparoscopic pyeloureteroplasty or ureteroureterostomy is one of the optimal treatments for ureteral polyp at present. The surgical method should be determined according to the number of polyps, the length and the diameter of the affected ureter, and also the status of renal function of the patients.

Fibroepithelial Polyp in a Child: A Rare Pathology of Upper Urinary Tract Obstruction

Fibroepithelial polyp is a rare benign tumor of the urothelial system that originates from the mesoderm. Polyps are usually small and located in the upper urinary tract and ureteropelvic junction. However, in the pediatric population, such polyps are more common in the posterior urethra and will present with symptoms of urinary tract obstruction. Some will present with flank pain and hematuria, resembling symptoms of ureteric stones. In this case, we discuss a nine-year-old boy presenting with complaints of flank pain and hematuria for one year. Following laboratory and radiological investigations, the left ureter was dilated at the mid-lumbar region with an anteroposterior diameter of 2.3 x 0.6 cm and a left renal pelvis anteroposterior diameter of 2.2 cm. An ultrasound scan identified an intraluminal lesion suspected to be a fibroepithelial polyp. Management was carried out via retroperitoneal surgery with upper ureteral resection and end-to-end anastomosis. Postoperatively, the patient’s symptoms improved, and a subsequent ultrasound scan and renal function test showed improvement of the left hydroureter and hydronephrosis.

Rare Fibroepithelial Polyp Extending Along the Ureter: A Case Report

Background:

Fibroepithelial polyps of the urinary tract are rare tumors, and their occurrence in the upper urinary tract is highly unusual.

Case Report:

This study reports a 9-year-old boy who presented to our clinic with complaints of unilateral flank pain and macroscopic hematuria. The direct urinary system graph did not show stone formation; therefore, magnetic resonance urography was performed. This revealed a filling defect in the left proximal ureter. On cystoscopy, a polyp was seen in the orifice of the left ureter, extending along the ureter. The polyp was resected by laser ablation and removed from the ureter. Histopathologic examination revealed a fibroepithelial polyp comprising fibrovascular stroma covered with transitional epithelium.

Conclusion:

Although extremely rare, a fibroepithelial polyp should be considered in the differential diagnosis when a young patient presents with flank pain and macroscopic hematuria. Endoscopic procedures may be the treatment of choice for polyps located in the upper ureter.