The Diagnosis and Management of Benign Fibrous Ureteric Polyps

Abstract

The diagnosis and management of benign fibrous ureteric polyps are discussed. A pre-operative diagnosis is suggested by a long history of loin pain or haematuria, both, in a younger patient with the radiological findings of ureteric obstruction or a radiolucent ureteric filling defect. The diagnosis is confirmed at operation by opening the ureter and exposing characteristic fronds of polyps arising from a common base. It is suggested that management should be conservative local excision and not nephroureterectomy, as previously practised.

Benign Ureteral Tumors

“…Obstruction, trauma, chronic irritation including infection and/or urolithiasis, hormonal imbalance, and allergic reactions have been discussed [1,4,8], but a dispositional malformation with an abortive attempt of ureter- al duplication must also be taken into consideration [9]. This thesis is supported by the fact that some polyps appear frequently in the 2nd to 4th decade of life and can even be found in children and newborns.…”

“…A necrotic ulceration of the polyp's tip is possible [9]. Clinically patients present with flank pain and colics, sometimes inguinally projected due to the partial ureteral obstruction.…”

“…The sex ratio (male/female, 3:2), side preference (twice as frequent on the left side) and the typical localization (60% at the infundibulum of the proximal ureter) of fibroepithelial polyps are still unclear [4,5,9]. Ureteral polyps usually appear as solitary tumors, nevertheless rare cases of multiple and bilateral appearance have been described [2].…”

Fibrous Polyp of the Ureter

“…The symptomatology of our cases was related to obstructive episodes in 2 cases (33.3%) who suffered renal colics (one of them due to a concomitant lithiasis). The lumbar pain, which was found in 3 cases (50%), because of its fre quency in patients with normal urinary systems, is not pathognomonic, although it has been the symptom which has induced the performance of intravenous urography and the discovery of a silent ureteral tumor (23).…”

Fibroepithelial Ureteral Polyps

“…Neither the unequal sex distribution (ratio male: female = 3:2) nor the slight preponderance of the left ure ter [5] is understood. Bilateral ureteral polyps and multi ple lesions in the same ureter have been described.…”