Treatment Of Child With Bilateral Ureteropelvic Junction Obstruction Due To Fibroepithelial Polyps And Review Of The Literature

Main Category: Urology / Nephrology
Article Date: 19 Sep 2008 - 10:00 PDT

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UroToday.com - A study from the Cleveland Clinic by Dr. Jason Romesburg, et al. discussed the case report of a child with bilateral ureteral pelvic junction obstruction due to fibroepithelial polyps. They reviewed the literature and found that fibroepithelial polyps represent the most common benign ureteral neoplasms in both children and adults. They are not typically a cause of urinary tract obstruction unless patients present with ipsilateral flank pain. Infrequently they may report hematuria as a primary complaint. All told, it appears to be rare event in children.

There seems to be an interesting trend, as our experience here at The Children's Hospital of Philadelphia is that fibroepithelial polyps are also on the rise. We have seen a different sort of phenotype in our institution where fibroepithelial polyps have become recurrent and are extremely multifocal. We are seeing them in a bilateral distribution. We have also seen an average of 10 polyps in each ureter per child. They have been recurrent for a number of months, even after laparoscopic oblation at their primary UPJ obstruction and also with endoscopic laser management. Careful documentation of where these tumors were first resected in the ureter shows that they are multi-focal and have not recurred in the same spot the second time. All of our observed tumors have been in the proximal 2/3 of the ureter except in 2 cases were we had one tumor at the ureteral orifice and another child even presented with fibroepithelial polyps along the urethra.

Fibroepithelial polyps, in my opinion, should be on the radar for children who are diagnosed with ureteral pelvic junction obstruction. This is especially true if they present with gross hematuria. MR urography as been helpful in distinguishing these tumors during the evaluation of a ureteral pelvic junction obstruction. Although this has not been proven to be an extremely sensitive specific modality, it is showing promise.

Romesburg JW, Stein RJ, Desai MM, Lagwinski N, Ross JH
Urology. 2008 Jul 23
doi:10.1016/j.urology.2008.04.040

Written by UroToday.com Medical Editor Pasquale Casale, MD

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