Obstruction of the ureter by neurofibroma of the urinary bladder treated endoscopically

Abstract

We present a case of a 23-year-old male with NF-1 diagnosed with bladder neurofibroma at childhood with regular ultrasound (US) follow-up since then, who presented with an obstructed left kidney. A detailed evaluation including blood tests and advanced imaging revealed left hydroureteronephrosis associated with a large bladder mass. The patient underwent cystoscopy and resection of the left ureteral orifice that was covered by the mass, and an indwelling ureteral stent was left in place. A follow-up US was performed one month after stent removal showing resolution of the hydronephrosis.

Keywords: Bladder neurofibroma; NF-1, Neurofibromatosis type 1; TUR, Transurethral resection; US, Ultrasonography; neurofibromatosis.

Fig. 1

Presenting Ultrasonography: Ultrasonography showing [a] hydronephrosis of the left kidney and [b] a bladder mass with dilated distal left ureter (arrowhead).

Fig. 2

Computed Tomography Urogram: Left hydroureteronephrosis is shown [a, b, c] due to large bladder mass obstructing the left ureter [d].

Fig. 3

Cystoscopy: Cystoscopy showing bladder posterior wall infiltration by the mass [a] that continues and obstructs the left ureteral orifice (arrowhead) [b]. The orifice was identified only after Indigo Carmine administration and a transurethral resection exposed a patent left ureter.