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Urethral polyp in neonate: a rare occurrence
Journal of Pediatric Surgery (2005) 40, E73 – E74
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Urethral polyp in neonate: a rare occurrence Amit Sitapara*, Sanjay Popat Department of Pediatrics, H.J. Doshi Sarvajanik Hospital and Medical Research Centre, Rajkot 360004 Gujarat, India Index words: Urethral polyp; Anterior urethra; Urethral polyp in neonates
Abstract Polyps of urethra as well as those in an anterior urethra in a male neonate are a rare abnormality, hence this publication. They usually present as either obstructive urinary symptoms in males or as an intralabial mass in females (Raviv G, Leibovitch I, Hanani J, et al., Hematuria and voiding disorders in children caused by congenital urethral polyps: principals of diagnosis and management. Eur Urol 1993;23:382. D 2005 Elsevier Inc. All rights reserved.
1. Case report
2. Discussion
A 2.4-kg male child who was one of the twins delivered through abdominal delivery at full term presented on the sixth day of life with complaint of swelling at the tip of the penis. The swelling appeared to be a glans penis dangling on the penile shaft, which gradually increases in size and was not associated with any urinary complaints or obstruction to flow. Antenatal ultrasound was not suggestive of hydronephrosis or oligohydroamnios. On examination, a single peanut-sized, pedunculated polyp with clear-cut vascular stalk entering the external urinary meatus at the 6-o’clock position was apparent (Fig. 1). External urinary opening, glans, prepuce, and penis were completely normal. Postnatal ultrasound was normal. During same anesthesia, cystoscopy was done to evaluate the whole urinary tract, which was found to be normal. The stalk of the polyp was clearly visible and was attached to the floor of glandular urethra proximal to the external urinary opening. It was excised using bipolar cautery, taking care of the external urethral opening so as not to create meatus stenosis (Fig. 2).
Urethral polyps are rarely encountered in daily practice [1]. They are more common in boys than girls and present with obstructive urinary symptoms [2,3]. Other modes of presentation are hematuria, infection, and interlabial mass in girls. A large lesion on long stalk may cause strangury also.
T Corresponding author. Laxmi Children Hospital, 2nd Floor, Opal Plaza, Aksharmarg-Aminmarg, Rajkot - 360001, Gujarat, India. Tel.: +91 0281 2458666. 0022-3468/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.07.051
Fig. 1
Preoperative photograph.
E74
A. Sitapara, S. Popat
They may arise as a result of developmental error in the invagination process of the glandular material of the inner zone of the prostate [4]. Posterior urethral polyps are considered vestiges of Mqller’s tubercle that fail to regress [5], whereas anterior urethral polyps have all arisen from dorsal 12-o’clock position deep in the bulbar urethra [6]. They have been reported in association with urethral duplication and vesiciureteral reflux. The exact etiology of these lesions has not been elucidated. They are usually benign. In young children, they represent other hamartomatous growth or response to inflammation, whereas in older children, they are congenital fibroepithelial polyps presenting most often between 7 to 9 years of age [5,7-9]. Hamartomatous polyps manifest as glands, cysts, and muscle or neurovascular tissue. They are nonneoplastic and lack papillary projections found on papilloma. Histologically, they are covered by transitional or squamous epithelium over a fibrovascular stalk. Other important differential diagnosis is polypoid hemangioma or urogenital rhabdomyosarcoma (Fig. 3) presenting as interlabial mass in females. The diagnosis is best made by voiding cystourethrogram and is confirmed by cystoscopy. On voiding cystourethrogram, to and fro mobility is pathognomonic. They may also be diagnosed by ultrasonography [10]. Transurethral resection is curative [11,12]. Other therapeutic approaches are suprapubic transvesical excision and open urethrotomy if located in anterior urethra. If completely excised, they generally do not recur [13].
Fig. 2
Postoperative photograph with bisected specimen.
Fig. 3
Histologic picture of urethral polyp.
References [1] Benziri E, et al. Prostatic epithelial polyps of the urethra. Br J Urol 1993;72:981. [2] Raviv G, Leibovitch I, Hanani J, et al. Hematuria and voiding disorders in children caused by congenital urethral polyps: principals of diagnosis and management. Eur Urol 1993;23:382. [3] Bagley FH, Davidson AE. Congenital urethral polyps in a children. Br J Urol 1976;48:275. [4] Walsh IK, Keane PF, Herron B. Benign urethral polyps. Br J Urol 1993;72:937. [5] Downs RA. Congenital polyps of the prostatic urethra: a review of the literature and report of two cases. Br J Urol 1970;42:76. [6] Redman JR, Robinson CM. Anterior urethral polyp in a child. J Pediatr Surg 1977;12:735. [7] Gunther I, Abrams HJ, Sutton AP, et al. Fibroepithelial polyp of the verumonatanum: a case report and review of literature. J Urol 1979;121:545. [8] Kearney LP, Lebowitz RL, Retik AB. Obstructive polyps of the posterior urethra in boys: embryology and management. J Urol 1979; 122:802. [9] Kimche D, Lash D. Congenital polyps of the prostatic urethra. J Urol 1982;127:134. [10] Atyrsgs J, et al. Sonographic diagnosis of polyps of the posterior urethra in children. J Clin Ultrasound 1993;21:188. [11] Zulin RAS, Brito RR, Borges HJ. Transurethral resection of pedunculated congenital polyps of the posterior urethra. Br J Urol 1982;54:45. [12] Gleson PE, Kraner SA. Genitourinary polyps in children. Urology 1994;44:106. [13] Frates R, Deluca FG. Urethral polyps in male children. Radiology 1967;89:2895.
www.elsevier.com/locate/jpedsurg
Urethral polyp in neonate: a rare occurrence Amit Sitapara*, Sanjay Popat Department of Pediatrics, H.J. Doshi Sarvajanik Hospital and Medical Research Centre, Rajkot 360004 Gujarat, India Index words: Urethral polyp; Anterior urethra; Urethral polyp in neonates
Abstract Polyps of urethra as well as those in an anterior urethra in a male neonate are a rare abnormality, hence this publication. They usually present as either obstructive urinary symptoms in males or as an intralabial mass in females (Raviv G, Leibovitch I, Hanani J, et al., Hematuria and voiding disorders in children caused by congenital urethral polyps: principals of diagnosis and management. Eur Urol 1993;23:382. D 2005 Elsevier Inc. All rights reserved.
1. Case report
2. Discussion
A 2.4-kg male child who was one of the twins delivered through abdominal delivery at full term presented on the sixth day of life with complaint of swelling at the tip of the penis. The swelling appeared to be a glans penis dangling on the penile shaft, which gradually increases in size and was not associated with any urinary complaints or obstruction to flow. Antenatal ultrasound was not suggestive of hydronephrosis or oligohydroamnios. On examination, a single peanut-sized, pedunculated polyp with clear-cut vascular stalk entering the external urinary meatus at the 6-o’clock position was apparent (Fig. 1). External urinary opening, glans, prepuce, and penis were completely normal. Postnatal ultrasound was normal. During same anesthesia, cystoscopy was done to evaluate the whole urinary tract, which was found to be normal. The stalk of the polyp was clearly visible and was attached to the floor of glandular urethra proximal to the external urinary opening. It was excised using bipolar cautery, taking care of the external urethral opening so as not to create meatus stenosis (Fig. 2).
Urethral polyps are rarely encountered in daily practice [1]. They are more common in boys than girls and present with obstructive urinary symptoms [2,3]. Other modes of presentation are hematuria, infection, and interlabial mass in girls. A large lesion on long stalk may cause strangury also.
T Corresponding author. Laxmi Children Hospital, 2nd Floor, Opal Plaza, Aksharmarg-Aminmarg, Rajkot - 360001, Gujarat, India. Tel.: +91 0281 2458666. 0022-3468/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.07.051
Fig. 1
Preoperative photograph.
E74
A. Sitapara, S. Popat
They may arise as a result of developmental error in the invagination process of the glandular material of the inner zone of the prostate [4]. Posterior urethral polyps are considered vestiges of Mqller’s tubercle that fail to regress [5], whereas anterior urethral polyps have all arisen from dorsal 12-o’clock position deep in the bulbar urethra [6]. They have been reported in association with urethral duplication and vesiciureteral reflux. The exact etiology of these lesions has not been elucidated. They are usually benign. In young children, they represent other hamartomatous growth or response to inflammation, whereas in older children, they are congenital fibroepithelial polyps presenting most often between 7 to 9 years of age [5,7-9]. Hamartomatous polyps manifest as glands, cysts, and muscle or neurovascular tissue. They are nonneoplastic and lack papillary projections found on papilloma. Histologically, they are covered by transitional or squamous epithelium over a fibrovascular stalk. Other important differential diagnosis is polypoid hemangioma or urogenital rhabdomyosarcoma (Fig. 3) presenting as interlabial mass in females. The diagnosis is best made by voiding cystourethrogram and is confirmed by cystoscopy. On voiding cystourethrogram, to and fro mobility is pathognomonic. They may also be diagnosed by ultrasonography [10]. Transurethral resection is curative [11,12]. Other therapeutic approaches are suprapubic transvesical excision and open urethrotomy if located in anterior urethra. If completely excised, they generally do not recur [13].
Fig. 2
Postoperative photograph with bisected specimen.
Fig. 3
Histologic picture of urethral polyp.
References [1] Benziri E, et al. Prostatic epithelial polyps of the urethra. Br J Urol 1993;72:981. [2] Raviv G, Leibovitch I, Hanani J, et al. Hematuria and voiding disorders in children caused by congenital urethral polyps: principals of diagnosis and management. Eur Urol 1993;23:382. [3] Bagley FH, Davidson AE. Congenital urethral polyps in a children. Br J Urol 1976;48:275. [4] Walsh IK, Keane PF, Herron B. Benign urethral polyps. Br J Urol 1993;72:937. [5] Downs RA. Congenital polyps of the prostatic urethra: a review of the literature and report of two cases. Br J Urol 1970;42:76. [6] Redman JR, Robinson CM. Anterior urethral polyp in a child. J Pediatr Surg 1977;12:735. [7] Gunther I, Abrams HJ, Sutton AP, et al. Fibroepithelial polyp of the verumonatanum: a case report and review of literature. J Urol 1979;121:545. [8] Kearney LP, Lebowitz RL, Retik AB. Obstructive polyps of the posterior urethra in boys: embryology and management. J Urol 1979; 122:802. [9] Kimche D, Lash D. Congenital polyps of the prostatic urethra. J Urol 1982;127:134. [10] Atyrsgs J, et al. Sonographic diagnosis of polyps of the posterior urethra in children. J Clin Ultrasound 1993;21:188. [11] Zulin RAS, Brito RR, Borges HJ. Transurethral resection of pedunculated congenital polyps of the posterior urethra. Br J Urol 1982;54:45. [12] Gleson PE, Kraner SA. Genitourinary polyps in children. Urology 1994;44:106. [13] Frates R, Deluca FG. Urethral polyps in male children. Radiology 1967;89:2895.