V09-01 PERCUTANEOUS ENDOSCOPIC MANAGEMENT FOR ATYPICAL PEDIATRIC URETEROPELVIC JUNCTION OBSTRUCTION

Abstract

INTRODUCTION AND OBJECTIVE: Ureteropelvic obstruction is a relatively common pathology amongst the pediatric population. Fibroepithelial polyps are more commonly seen in the adult setting, and are more commonly found in the distal ureter. In the pediatric setting, these polyps cause ureteropelvic junction obstruction in only 0.5% of patients. We present here an innovative percutaneous approach towards management of polyp-induced ureteropelvic junction obstruction in the pediatric setting. METHODS: We present the case of a 12 year old male who presented to the ER acutely for refractory L sided flank pain. He had complained of several months of left sided flank pain that had gradually worsened. His history was notable for hydronephrosis as an infant but was not worked up further given a normal nuclear medicine renal scan. An outpatient MRI demonstrated moderate left sided hydronephrosis with several filling defects outlining the ureteropelvic junction. Based on team discussion with the family, decision was made to proceed with percutaneous endoscopic ablation. RESULTS: Once in the operating room, a lateral calyx was selected for bulls-eye puncture. In the collecting system, multiple benign appearing polypoid lesions appeared to obscure the ureteropelvic junction. We opted to use a Holmium 200 micron laser fiber to ablate the base of the lesion assisted by use of flexible grasping forceps. Pathology demonstrated fibroepithelial polyp and the patient was left with a double-J ureteral stent for several weeks and a foley catheter in the renal pelvis that was removed on post operative day 2. CONCLUSIONS: While fibroepithelial polyps are rare in children and an even rarer etiology of ureteropelvic junction obstruction, suspicion must remain high especially in light of filling defects on contrast imaging. We present here an innovative, safe and effective use of percutaneous endoscopic ablation for management of fibroepithelial polyp induced ureteropelvic junction obstruction in the pediatric setting. Source of Funding: None