Antenatal mild hydronephrosis with subsequent polyp of the upper ureter in a child presenting with recurrent Dietl's crisis

Abstract

We report a 7-year-old boy who had antenatally diagnosed and postnatally confirmed asymptomatic right congenital hydronephrosis secondary to ureteropelvic junction obstruction with the anteroposterior diameter ranging from 7 to 15 mm on serial ultrasound scans till the age of 6 years. He then presented with recurrent attacks of Dietl's crisis almost every month in the seventh year of his life and eluded diagnosis for over a year at various national hospitals, and ended up with an international referral to us. Investigations of the acute attacks clinched the diagnosis of ureteral polyp causing intermittent crisis and he underwent segmental resection and reconstruction in the form of dismembered Anderson-Hyne pyeloplasty with good recovery. Our case revealed that prenatally detected hydronephrosis may worsen after spontaneous postnatal improvement and a polyp acting as a flip valve may produce intermittent hydronephrosis and symptoms later in life. The child should undergo urgent investigations during acute symptoms.

Benign fibroepithelial bladder polyp: a rare cause of childhood haematuria

“…They are mostly found in ureter, urethra and pelvis and are distinctly rare in urinary bladder. [5][6][7] They are more common in adult men and rare in children. Other benign lesions that may be found in the bladder include leiomyomas, granulomas, haemangiomas and urothelial and non-urothelial neoplasms.…”

Delayed Recognition of an Ureteropelvic Junction Obstruction in a Young Adult Female

“…The most common etiologies are external compression from an aberrant vessel providing circulation of the lower pole of the kidney or intrinsic malformation of a segment of proximal ureter [ 2 ]. Less common causes include high ureteral insertion or a ureteral polyp [ 3 ].…”

“…Some cases do not become symptomatic until adulthood with pain precipitated by diuresis-inducing beverages such as coffee or alcohol. Often symptoms are vague and referred to the abdomen or pelvis [ 3 ]. Patients report intermittent bouts of pain with normal physical exam findings and imaging studies during periods of quiescence.…”

Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children

“…Recent studies have shown that as low as 5%–22% of UFPs could be diagnosed without surgery. 5 To better diagnose and treat UFPs in children, pathologically proven cases between 2017 and 2020 were reviewed in the Urology Department (II), Anhui Provincial Children’s Hospital. All cases in the series had undergone laparoscopic surgery and achieved favorable outcomes according to postoperative follow-up.…”