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Fibroepithelial Polyp of the Verumontanum: A Case Report and Review of the Literature
0022-534 7/79/1214-0525$02.00/0 Vol. 121, April
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright © 1979 by The Williams & Wilkins Co.
FIBROEPITHELIAL POLYP OF THE VERUMONTANUM: A CASE REPORT AND REVIEW OF THE LITERATURE IRINA GUNTHER, HENRY J. ABRAMS, ALBERT P. SUTTON
AND
MITCHELL I. BUCHBINDER
From the Division of Urology, Department of Surgery, Long Island Jewish-Hillside Medical Center, New Hyde Park, New Yark
ABSTRACT
A fibrous polyp of the verumontanum in a 10-year-old boy is described. The diagnosis, treatment and histology are discussed and the literature is reviewed. Perhaps this lesion will be noted more frequently with the availability of improved radiographic and cystoscopic techniques. The treatment has been greatly simplified with the advent of the pediatric resectoscope.
FIG. 1. !VP shows round bladder filling defect 1 cm. above bladder neck
Problems of disturbed micturition regularly confront pediatric urologists. Congenital polyps of the posterior urethra are uncommon causes of urethral obstruction, with only 44 cases reported previously. 1-l< Herein we report a case in which the polyp was visualized on the excretory urogram (IVP). CASE REPORT
A 10-year-old white boy was hospitalized because of nocturia, frequency, hesitancy and suprapubic pain 10 days in duration. He had been treated for a urinary infection with ampicillin 2 weeks previously. Physical examination and laboratory studies were normal. An IVP revealed normal upper tracts bilaterally. A smooth, round, filling defect was apparent in the bladder 1 cm. above the base of the bladder (fig. 1l. A voiding cystourethrogram revealed a mobile filling defect in the posterior urethra. Cystopanendoscopy revealed a polypoid mass arising from the verumontanum, which protruded into the bladder. When the panendoscope was withdrawn the polyp was noted to occlude the bladder neck. A transurethral resection of the pedunculated lesion was done. An indwelling Foley catheter was maintained for 24 hours. The patient voided spontaneously after removal of the catheter. Histologic sections revealed fragments of fibrocollagenous tissue admixed with hyperplastic bundles of smooth muscle tissue. The fragments were lined b:v transitional epithelium Accepted for publication August 11, 1978.
FIG. 2. High power view of polyp covered by transitional cell epithelium and consisting of connective tissue core with numerous vessels.
(fig. 2). This histologic picture was consistent with a fibroepithelial polyp of the verumontanum. DISCUSSION
According to Downs congenital polyps of the posterior urethra arise as a defective protrusion of the urethral wall. 1 They 52.5
526
GUNTHER AND ASSOCIATES
most commonly occur in infancy and childhood. The youngest patient described was 3 weeks old4 and the average age at diagnosis is 7 to 9 years. The usual complaints of dysuria, hematuria, straining to void and urinary retention are related to bladder outlet obstruction. The onset of symptoms may be sudden despite a severe degree ofhydronephrosis. The degree of obstruction varies from advanced hydronephrosis and hydroureter to normal upper tracts. Visualization of the polyp as a filling defect on IVP has been described. 2• 6 Ureteral reflux occurs in approximately 40 per cent of the cases. The diagnosis is made on a voiding cystourethrogram and panendoscopy. The characteristic, rounded filling defect in the prostatic urethra changes its position in different x-ray exposures, which aids in differe11tiating other causes of urethral obstruction. Of the previously reported cases 28 were approached suprapubically. In the most recent 16 cases the polyps were removed by transurethral resection. Fibroepithelial urethral polyps should be distinguished from hypertrophy of the verumontanum. 2 The histology of hypertrophy of the verumontanum reveals an increase in all compo-
nent tissues, including glandular structures. Fibroepithelial polyps contain only fibrous elements. REFERENCES
1. Downs, R. A.: Congenital polyps of the prostatic urethra. A
2. 3. 4. 5. 6. 7. 8.
review of the literature and report of two cases. Brit. J. Urol., 42: 76, 1970. Kuppusami, K. and Moors, D. E.: Fibrous polyp of the verumontanum. Canad. J. Surg., 11: 388, 1968. Stueber, P. J. and Persky, L.: Solid tumors of the urethra and bladder neck. J. Urol., 102: 205, 1969. DeWolf, W. C. and Fraley, E. E.: Congenital urethral polyp in the infant: case report and review of the literature. J. Urol., 109: 515, 1973. Stadaas, J. 0.: Pedunculated polyp of posterior urethra in children causing reflux and hydronephrosis. J. Ped. Surg., 8: 517, 1973. Williams, D. I. and Abbassian, A.: Solitary pedunculated polyp of the posterior urethra in children. J. Urol., 96: 483, 1966. Meadows, J. A., Jr. and Quattlebaum, R. B.: Polyps of the posterior urethra in children. J. Urol., 100: 317, 1968. Lou, E. S., Kogan, S. J., Newman, H. and Levitt, S. B.: Prolapsing urethral polyp in child with hypospadias. Urology, 9: 423, 1977.
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright © 1979 by The Williams & Wilkins Co.
FIBROEPITHELIAL POLYP OF THE VERUMONTANUM: A CASE REPORT AND REVIEW OF THE LITERATURE IRINA GUNTHER, HENRY J. ABRAMS, ALBERT P. SUTTON
AND
MITCHELL I. BUCHBINDER
From the Division of Urology, Department of Surgery, Long Island Jewish-Hillside Medical Center, New Hyde Park, New Yark
ABSTRACT
A fibrous polyp of the verumontanum in a 10-year-old boy is described. The diagnosis, treatment and histology are discussed and the literature is reviewed. Perhaps this lesion will be noted more frequently with the availability of improved radiographic and cystoscopic techniques. The treatment has been greatly simplified with the advent of the pediatric resectoscope.
FIG. 1. !VP shows round bladder filling defect 1 cm. above bladder neck
Problems of disturbed micturition regularly confront pediatric urologists. Congenital polyps of the posterior urethra are uncommon causes of urethral obstruction, with only 44 cases reported previously. 1-l< Herein we report a case in which the polyp was visualized on the excretory urogram (IVP). CASE REPORT
A 10-year-old white boy was hospitalized because of nocturia, frequency, hesitancy and suprapubic pain 10 days in duration. He had been treated for a urinary infection with ampicillin 2 weeks previously. Physical examination and laboratory studies were normal. An IVP revealed normal upper tracts bilaterally. A smooth, round, filling defect was apparent in the bladder 1 cm. above the base of the bladder (fig. 1l. A voiding cystourethrogram revealed a mobile filling defect in the posterior urethra. Cystopanendoscopy revealed a polypoid mass arising from the verumontanum, which protruded into the bladder. When the panendoscope was withdrawn the polyp was noted to occlude the bladder neck. A transurethral resection of the pedunculated lesion was done. An indwelling Foley catheter was maintained for 24 hours. The patient voided spontaneously after removal of the catheter. Histologic sections revealed fragments of fibrocollagenous tissue admixed with hyperplastic bundles of smooth muscle tissue. The fragments were lined b:v transitional epithelium Accepted for publication August 11, 1978.
FIG. 2. High power view of polyp covered by transitional cell epithelium and consisting of connective tissue core with numerous vessels.
(fig. 2). This histologic picture was consistent with a fibroepithelial polyp of the verumontanum. DISCUSSION
According to Downs congenital polyps of the posterior urethra arise as a defective protrusion of the urethral wall. 1 They 52.5
526
GUNTHER AND ASSOCIATES
most commonly occur in infancy and childhood. The youngest patient described was 3 weeks old4 and the average age at diagnosis is 7 to 9 years. The usual complaints of dysuria, hematuria, straining to void and urinary retention are related to bladder outlet obstruction. The onset of symptoms may be sudden despite a severe degree ofhydronephrosis. The degree of obstruction varies from advanced hydronephrosis and hydroureter to normal upper tracts. Visualization of the polyp as a filling defect on IVP has been described. 2• 6 Ureteral reflux occurs in approximately 40 per cent of the cases. The diagnosis is made on a voiding cystourethrogram and panendoscopy. The characteristic, rounded filling defect in the prostatic urethra changes its position in different x-ray exposures, which aids in differe11tiating other causes of urethral obstruction. Of the previously reported cases 28 were approached suprapubically. In the most recent 16 cases the polyps were removed by transurethral resection. Fibroepithelial urethral polyps should be distinguished from hypertrophy of the verumontanum. 2 The histology of hypertrophy of the verumontanum reveals an increase in all compo-
nent tissues, including glandular structures. Fibroepithelial polyps contain only fibrous elements. REFERENCES
1. Downs, R. A.: Congenital polyps of the prostatic urethra. A
2. 3. 4. 5. 6. 7. 8.
review of the literature and report of two cases. Brit. J. Urol., 42: 76, 1970. Kuppusami, K. and Moors, D. E.: Fibrous polyp of the verumontanum. Canad. J. Surg., 11: 388, 1968. Stueber, P. J. and Persky, L.: Solid tumors of the urethra and bladder neck. J. Urol., 102: 205, 1969. DeWolf, W. C. and Fraley, E. E.: Congenital urethral polyp in the infant: case report and review of the literature. J. Urol., 109: 515, 1973. Stadaas, J. 0.: Pedunculated polyp of posterior urethra in children causing reflux and hydronephrosis. J. Ped. Surg., 8: 517, 1973. Williams, D. I. and Abbassian, A.: Solitary pedunculated polyp of the posterior urethra in children. J. Urol., 96: 483, 1966. Meadows, J. A., Jr. and Quattlebaum, R. B.: Polyps of the posterior urethra in children. J. Urol., 100: 317, 1968. Lou, E. S., Kogan, S. J., Newman, H. and Levitt, S. B.: Prolapsing urethral polyp in child with hypospadias. Urology, 9: 423, 1977.