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

Abstract

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.

Keywords: fibroepithelial polyp; hydronephrosis; hydroureter; upper urinary tract obstruction.

Figure 1. Intravenous Pyelogram of the Left Upper Ureter

Intravenous pyelogram showing a left upper ureteric defect.

Figure 2. Intraoperative Dissection

A large polyp with a smooth surface was seen inside the ureter.

Figure 3. The Postoperative Ultrasound Scan

A postoperative ultrasound scan showing normal findings. (A) Left upper ureter. (B) Left proximal ureter. (C) Left renal pelvis. (D) Left kidney.