Endoscopic Management of Ureteral Fibroepithelial Polyps

Abstract

Introduction: Although the ureteral fibroepithelial polyps are rather uncommon, an increase of their incidence was recorded during the recent period, probably because of better access to the investigative methods.1,2 The aim of this study was to determine the diagnosis and endoscopic treatment particularities in these patients. Materials and Methods: Our experience was based on eight patients evaluated during the last 10 years. The average patients' age was 32 years (between 26 and 49). Hematuria, suprapubic discomfort, flank pain, and urinary frequency were the main symptoms. Diagnosis was based on ultrasonography, intravenous pyelography (IVP), urethrocystoscopy, retrograde ureteropyelography, and ureteroscopy.3,4 Most of the authors report the last open surgical management of these polyps in the 90s.5 Although Ho:YAG laser's properties recommend it now as the ideal tool in ureteral fibroepithelial polyps treatment,4 this energy source is not available in every urological department. In the recent reported series the fibroepithelial polyps were treated using fulguration electrodes, cold biopsy forceps, baskets, lasers, etc.4–6 Results and Conclusions: In three patients were discovered smooth polypoid masses covered by apparently normal urothelium and protruding through the ureteral orifice. In four patients, the fibroepithelial polyps appeared as large ureteral filling defects in the lower ureter. In the last patient, a large, organized, blood clot protruding from the left orifice imposed ureteroscopy with the identification of a mid-ureteral polyp. Seven patients were treated by ureteroscopic Nd:YAG laser ablation. Transureteral resection was applied (the lasers being unavailable in our department at the time) in one patient. We used a Storz 12F ureteroresectoscope with cutting loop. This was the only patient treated by electroresection due to the concerns regarding the potential of the method to generate ureteral strictures. Nd:YAG laser, despite its deeper penetrability by comparison to Ho:YAG, proved to be safe and effective in excising the polyps, offering good control of the tumoral base and ureteral wall. No perforations were encountered in these patients. After complete excision of the polypoid base, a Double-J stent was indwelled for 4–6 weeks. Histology described the lesions as fibroepithelial polyps: hyperplastic urothelium overlying an intact basement membrane with extensive submucosal edema, dilated blood vessels, chronic inflammatory cells, and fibrous stroma. The follow-up protocol included ultrasonography, IVP, retrograde pyelography, and ureteroscopy. No recurrences and no ureteral strictures were found after a mean follow-up period of 48 months (range 3 to 72 months). Ureteral fibroepithelial polyps represent a rare pathology and ureteroscopy remains the gold-standard diagnostic method. The appearance and location of the lesions are pathognomonic, and complete excision may be performed by ureteroscopic approach. Recurrences seem to be rare in these tumors. No competing financial interests exist. Runtime of video: 7 min 1 sec