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Tao C, Cao Y, Mao C. Analysis of the Therapeutic Efficacy of Laparoscopic Treatment for Fibroepithelial Polyps of the Ureter in Children. J Endourol 2024; 38:219-227. [PMID: 38185850 DOI: 10.1089/end.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The aim of this study is to assess the efficacy and safety of laparoscopic surgery in the treatment of pediatric ureteral fibroepithelial polyp (FEP) patients. Our hypothesis is that laparoscopic surgery can effectively treat FEPs while minimizing patient discomfort and complications. Our research aims to evaluate the clinical outcomes of the surgery, including postoperative symptom relief, improvement in kidney function, and risk of postoperative complications. Methods: The clinical records of 34 patients who underwent ureteral polyp surgery at the Department of Urology at Anhui Provincial Children's Hospital between May 2014 and February 2023 were retrospectively analyzed. All patients underwent laparoscopic surgery. Among the 34 pediatric patients, there were 31 males and 3 females, with 2 on the right side and 32 on the left side. Of these cases, 24 polyps were located at the ureteropelvic junction, while seven were found in the upper segment of the ureter and three in its middle segment. Patients' ages ranged from 4 years and 3 months to 15 years, with a median age of 8 years and 6 months. All children presented with varying degrees of hydronephrosis, and preoperative clinical symptoms included ipsilateral flank or abdominal pain, hematuria, and other discomfort. Preoperative examinations mainly comprised ultrasound, intravenous pyelography, CT, or magnetic resonance urography imaging studies, as well as diuretic renography. All pediatric patients underwent laparoscopic excision of the polyp segment of the ureter, followed by renal pelvis ureteroplasty or ureter-to-ureter anastomosis. Results: All patients underwent surgery without conversion to open surgery. The surgical duration ranged from 72 to 313 minutes, with an average of 179.5 minutes. The average intraoperative blood loss was 14 mL. Postoperatively, one patient experienced leakage at the anastomotic site; however, no other significant complications occurred during or after the procedure. Postoperative histopathology confirmed the presence of FEPs in the ureter for all cases. All patients experienced a favorable postoperative recovery, with hospitalization periods ranging from 3 to 16 days and an average stay of 8.6 days. A Double-J stent was inserted in all patients for a duration of 1 to 2 months after surgery, and upon removal, follow-up color Doppler ultrasound revealed reduced hydronephrosis within 1 to 3 months. Follow-up examinations were conducted at intervals ranging from 3 to 108 months postsurgery, with an average follow-up time of 42.2 months, during which no recurrence of ureteral polyps or symptoms such as pain and hematuria was observed. Conclusions: The findings of this study demonstrate that laparoscopic excision of the polyp segment of the ureter, renal pelvis ureteroplasty, and ureter-to-ureter anastomosis represent safe and effective treatment modalities for pediatric FEPs in the ureters. This technique offers several advantages, including minimal invasiveness, rapid recovery, and definitive therapeutic efficacy, which effectively alleviate clinical symptoms and improve hydronephrosis.
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Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
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Cho SY, Oh KJ, Jung W, Kim HJ, Lee SH, Lee JY, Lee DS. The natural course of incidental ureteral polyp during ureteroscopic surgery: KSER research. BMC Urol 2023; 23:101. [PMID: 37316777 DOI: 10.1186/s12894-023-01249-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/14/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The natural course of polypoid lesions in the ureter during ureteroscopic stone surgery was not yet clarified. METHODS Patient data were collected prospectively from six teaching hospitals between 2019 and 2021. Patients with polypoid lesions in the ureter distal to ureteral stones were included during ureteroscopy. Computed tomography was performed on all enrolled patients three months after the procedure. Follow-up ureteroscopy was performed only if the patient consented, due to the need for general anesthesia and ethical considerations. RESULTS Among the 35 patients who were followed up, 14 had fibroepithelial polyps and 21 had inflammatory polyps. Twenty of the followed-up patients underwent ureteroscopy, and nine of them had fibroepithelial polyps. Although fibroepithelial polyps did not disappear in the follow-up ureteroscopy (p = 0.002), the rate of postoperative hydronephrosis was not higher in the fibroepithelial group than in the inflammatory group. Postoperative ureteral stricture and moderate-to-severe hydronephrosis were found to be closely related to the number of resected polyps, regardless of the type of polyp (p = 0.014 and 0.006, respectively). CONCLUSION Fibroepithelial polyps in the ureter may persist after treatment of adjacent ureter stones. However, conservative management may be preferable to active removal of ureteral polyps because fibroepithelial polyps may not contribute to clinically significant hydronephrosis after surgery, and inflammatory polyps disappear spontaneously. Hasty resections of polyps may increase the risk of ureteral stricture.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University, College of Medicine, Seoul, South Korea
| | - Kyung-Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, South Korea
| | - Wonho Jung
- Department of Urology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyung Joon Kim
- Department of Urology, Konyang University Hospital, Daejeon, South Korea
| | - Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, Seoul, South Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's hospital, The Catholic University of Korea, Suwon, South Korea.
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Walls SP, Akinboboye O, Opoku I, Da Silva RC. Large Fibroepithelial Stromal Polyp of the Breast Nipple. Cureus 2022; 14:e26397. [PMID: 35911358 PMCID: PMC9333339 DOI: 10.7759/cureus.26397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Fibroepithelial stromal polyps (FEPs) are benign tumors of the integumentary system with mesodermal origin. They are commonly found over the skin. Rarely, they can be found in the nipple. We report a case in a 62-year-old female with a large FEP emerging from the left breast nipple. It started as a “mole” 10 years ago and slowly progressed in size. The patient did not complain of pain but did report occasional bloody discharge. She has no family history of breast cancer. On physical exam, a pedunculated large polyp, with rubbery consistency, emerging from the left nipple was noted. The lesion consisted of hyper-pigmentation with scattered ulcerations and cauliflower-like growth. Surgical excision was performed and histopathologic analysis showed extensive fibrovascular tissue with dense collagen fibers deposition consistent with FEP. Surgical treatment is curative with minimal skin deformity. In order to make the diagnosis and exclude malignancy, histopathology is mandatory.
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Chen Z, Lin H, Xu M, Xu G, Fang X, He L, Geng H. The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients. J Pediatr Urol 2020; 16:458.e1-458.e6. [PMID: 32448600 DOI: 10.1016/j.jpurol.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Most patients with intermittent hydronephrosis have preserved differential renal function (DRF), while others already have impaired DRF at diagnosis. We summarized the clinical manifestations of intermittent hydronephrosis to elucidate what may be related to DRF loss. STUDY DESIGN We retrospectively reviewed patients presenting to our department with unilateral Dietl's Crisis between January 2014 and December 2017. Clinical characteristics were collected, including age of first onset, time of onset, duration of the longest single episodes and whether the patient had prenatally detected hydronephrosis. Ultrasonographic (US) parameters included anteroposterior diameter (APD) during the symptomatic and asymptomatic period. Dynamic renograms (DR) were reviewed to obtain preoperative DRF. RESULTS A total of 150 patients met the selective criteria. Of the 128 patients whose mother had regular obstetric ultrasounds during pregnancy, 50 (39.06%) had prenatally detected pelvic dilation. The mean age of the first attack was earlier in the prenatally detected hydronephrosis group than in the postnatally detected group (4.58 vs 5.87, p = 0.002). The mean preoperative DRF was 41.03% in all of the patients. The patients whose DRFs were below 40% had longer durations of single attacks than those over 40%. The former group also had larger APD during the symptomatic periods than the latter group. The risk of DRF < 40% was higher in the patients whose APD at attack was greater than 35 mm (OR=5.111, χ2=12.899, p < 0.001). The attack times, waiting time before the surgery and age of the first onset had no association with preoperative DRF. DISCUSSION Our study first found that in patients with Dietl's Crisis, the APD during the symptomatic periods and the longest duration of the attack were associated with DRF loss. But the retrospective nature of our study limited us to understand the relationship between DRF and total duration of all attacks. CONCLUSION This study revealed that children with prenatal hydronephrosis could develop Dietl's Crisis at early ages. A longer duration of attack and larger APD during the attack were associated with impaired DRF.
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Affiliation(s)
- Zhoutong Chen
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Houwei Lin
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Maosheng Xu
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Guofeng Xu
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xiaoliang Fang
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lei He
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Hongquan Geng
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Köseoğlu H, Eroğlu T, Akdemir C, Turan H, Leblebici C. Incidental ureteral fibroepithelial polyp. Proc (Bayl Univ Med Cent) 2020; 33:684-685. [PMID: 33100571 DOI: 10.1080/08998280.2020.1783968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Although rare, fibroepithelial polyp of the ureter is the most common type of benign urinary tract mesodermal tumor. It may cause symptoms such as hematuria, dysuria, and flank pain or be asymptomatic. Here we report incidental intraoperative detection of a left ureteral fibroepithelial polyp during an elective gyno-oncological surgery for left-sided ovarian thecoma.
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Affiliation(s)
- Hikmet Köseoğlu
- Department of Urology, Health Sciences University, Istanbul Education & Research Hospital, Istanbul, Turkey
| | - Tolga Eroğlu
- Department of Urology, Health Sciences University, Istanbul Education & Research Hospital, Istanbul, Turkey
| | - Celal Akdemir
- Department of Gynecology & Obstetrics, Health Sciences University, Istanbul Education & Research Hospital, Istanbul, Turkey
| | - Hasan Turan
- Department of Gynecology & Obstetrics, Health Sciences University, Istanbul Education & Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Health Sciences University, Istanbul Education & Research Hospital, Istanbul, Turkey
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Bansal D, Maheshwari R, Chaturvedi S, Kumar A. Giant ureteral fibro-epithelial polyp: A rare but important differential of ureteral urothelial cell carcinoma. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820931629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Fibro-epithelial polyps (FEPs) of the ureter are rare benign tumours and constitute an important differential for ureteral urothelial cell carcinoma (UCC). Case presentation: We describe a case of a 56-year-old lady presenting with gross haematuria. On initial evaluation elsewhere, she was diagnosed with lower ureteric UCC and was advised left nephroureterectomy. Careful evaluation at our centre established the diagnosis of a left ureteral FEP. Robot-assisted excision of the ureteral FEP was successfully done. Conclusion: Diagnosis of these rare tumours may be made with a combination of imaging, ureteroscopy and histopathological analysis. Resection of giant FEPs may be done with a robot-assisted technique. Proper diagnosis and management of these tumours are essential to avoid unnecessary nephroureterectomies. Level of evidence: 4
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Uro-oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi and NCR, India
| | - Ruchir Maheshwari
- Department of Urology, Uro-oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi and NCR, India
| | - Samit Chaturvedi
- Department of Urology, Uro-oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi and NCR, India
| | - Anant Kumar
- Department of Urology, Uro-oncology, Robotics and Renal Transplant, Max Group of Hospitals, Delhi and NCR, India
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