0022-5347/01/1655-1627/0 THE JOURNAL OF UROLOGY® Copyright © 2001 by AMERICAN UROLOGICAL ASSOCIATION, INC.®
Vol. 165, 1627–1628, May 2001 Printed in U.S.A.
URETERAL FIBROEPITHELIAL POLYP PROLAPSED INTO THE BLADDER CAVITY SUSPENDING A BLADDER STONE CHIN-CHUNG YEH,* HSIEN-CHIH LIN, CHANG-CHUNG CHEN
From the Department of Urology, China Medical College Hospital, Taichung City, Taiwan, Republic of China KEY WORDS: ureter, polyp, bladder, bladder calculi, ureteroscopy
Ureteral fibroepithelial polyps are rare, although they are the most common benign tumor of the ureter.1, 2 A review of the literature on MEDLINE revealed 255 articles related to ureteral fibroepithelial polyps published between 1966 and 2000. To our knowledge we report the first case of a ureteral fibroepithelial polyp to prolapse into the bladder cavity and suspend a bladder stone.
(part E of figure). After cystolithotripsy, cystolitholapaxy and left ureteroscopic polypectomy, a Double-J† internal ureteral stent was inserted (part G of figure). Histological study of the resected specimen indicated an inflamed fibroepithelial polyp.
A ureteral fibroepithelial polyp was first reported in 1932.2 Until 1994 about 140 cases of fibroepithelial polyps had been reported in the English literature.2 Although rare, it is the most common benign ureteral tumor. 1, 2 Chronic infection and congenital factors are considered to be the cause of ureteral fibroepithelial polyps. Although ureteral polyps and urinary calculi are known to cause chronic irritation, not many cases have demonstrated infections with polyps. Ureteral fibroepithelial polyps can present clinically with painless gross hematuria, hydronephrosis or a ureteral stone. Hematuria is the most common presenting symptom.1–3 Obstruction of ureteral polyps might induce hydronephrosis, which is usually detected incidentally on routine physical examination with sonography. The treatment of ureteral fibroepithelial polyps includes local coagulation by laser, polypectomy by ureteroscopy, segmental resection with ureteroureterostomy or nephroureterectomy when misdiagnosis is transitional cell carcinoma of ureter. To our knowledge we report the first case of a ureteral fibroepithelial polyp prolapsed into the bladder cavity suspending a large bladder stone. The bladder stone was fragmented by electrohydraulic lithotripsy, and the polyps were resected by ureteroscopy.
A 42-year-old man presented with painful gross hematuria. He appeared acutely ill on physical examination but mentally alert. Vital signs were normal and no abnormal physical findings were found. Urinalysis revealed several red and white blood cells, and film of the kidneys, ureters and bladder detected a bladder stone of about 2.5 cm. (part A of figure). Excretory urography demonstrated hydronephrosis and hydroureter induced by left lower ureteral obstruction. Renal echogram showed moderate hydronephrosis and a thick renal cortex. Cystoscopy revealed mucosa edema (part B of figure) of the right ureteral orifice, and a bladder stone that was suspended by a ureteral fibroepithelial polyp (part C of figure) prolapsed from the left ureteral orifice. The bladder stone was attached by the ureteral fibroepithelial polyp on its lateral side. The stone was fragmented by electrohydraulic lithotripsy using cystoscopy but was incompletely separated from the polyp (part F of figure). Ureteroscopy revealed a ureteral lumen occupied by a fibroepithelial polyp (part D of figure). The polyp was grasped by basket for traction and resected over the root area through the ureteroscope. The base of the polyp was coagulated by an electrode Accepted for publication December 1, 2000. *Requests for reprints: No. 2, Yuh-Der Rd., Taichung City, Taiwan.
†Medical Engineering Corp., New York, New York.
A, x-ray shows bladder stone (arrow) about 2.5 cm. in diameter. B, cystoscopy reveals right ureteral orifice with periureteral mucosa edema (arrowhead) and bladder stone (arrow). C, cystoscopy shows bladder stone suspended by ureteral fibroepithelial polyp prolapsed from left ureter. Arrowhead indicates stalk of polyp. D, ureteroscopy demonstrates ureteral lumen (arrow) occupied by polyp. E, base of polyp is coagulated by electrode after polyp resection. F, bladder stone is incompletely separated from polyp. G, ureteral stent is inserted after ureteroscopic resection. 1627
URETERAL FIBROEPITHELIAL POLYP SUSPENDING BLADDER STONE
Ms. Hsiu-Chen Lu helped prepare the figure. REFERENCES
1. Oesterling, J. E., Liu, H. Y. and Fishman, E. K.: Real-time, multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a distal
ureteral fibroepithelial polyp and adjacent calculus. J Urol, 142: 1563, 1989 2. Bolton, D., Stoller, M. L. and Irby, P., III: Fibroepithelial ureteral polyps and urolithiasis. Urology, 44: 582, 1994 3. Kiel, H., Ullrich, T., Roessler, W. et al: Benign ureteral tumors. Four case reports and a review of literature. Urol Int, 63: 201, 2000