Ureteral fibroepithelial polyp protruding into the bladder which mimics a bladder tumour: a case report and literature review

Abstract

Background: Ureteral fibroepithelial polyp is a rare benign lesion of the urinary tract. The incidence of the disease has been increasing recently; however, the aetiology of this tumour remains unclear. Early diagnosis and management are important, and endoscopic treatment is increasingly being preferred worldwide.Case Description: We report the case of a 49-year-old patient who presented with urinary frequency, intermittent haematuria, and an echogenic bladder mass found on pelvic sonography. Cystoscopy revealed an irregularly shaped large bladder mass, suggesting a benign or malignant bladder tumour. On subsequent examination, intravenous urography (IVU) and computed tomography showed a large lobulated contour filling defect in the bladder, measuring approximately 4 cm, with a suspected finding of a long stalk in the left distal ureter. Ureteroscopy revealed a long and narrow pedunculated tumour in the left distal ureter protruding into the bladder cavity through the ureteral orifice. On endoscopic excision, the attached stalk of the polyp into the ureter was cut using holmium:yttrium aluminium garnet (YAG) laser. The polyp was completely excised and extracted in its entirety, including the section protruding into the bladder.Histopathological findings confirmed the diagnosis of a fibroepithelial polyp. There was no sign of complication or recurrence on computed tomography performed after 12 months. Conclusions:The ureteral fibroepithelial polyp protruding into the bladder mimicked a bladder tumour and was successfully treated by endoscopic resection, with no complications or recurrence. Endoscopic treatment is an effective and safe method to treat fibroepithelial polyps of the ureter.

Endoscopic treatment of a ureteral inflammatory polyp in a 15-year-old Warmblood gelding

“…FP typically present as smooth, mobile, and pedunculated masses in the ureter (Lam et al 2003). They cause ureteral obstruction with consequent clinical symptoms: flank or lower abdominal pain, macroscopic hematuria, irritating bladder symptoms, including frequency and urgency when it protrudes into the bladder (Lam et al 2003, Ludwig et al 2015, Kumar et al 2022, Kim et al 2022). Cases of FP have been described in cats and dogs (Reichle et al 2003, Grant & Troy 2014, Etzioni et al 2020) and in a 4-month-old foal as well (Jones et al 1994).…”

Endoscopic treatment of a ureteral inflammatory polyp in a 15‐year‐old Warmblood gelding

“…FP typically present as smooth, mobile and pedunculated masses in the ureter (Lam et al., 2003). They cause ureteral obstruction with consequent clinical signs: flank or lower abdominal pain, macroscopic haematuria and irritating bladder symptoms, including frequency and urgency when it protrudes into the bladder (Kim et al., 2022; Kumar et al., 2022; Lam et al., 2003; Ludwig et al., 2015). Cases of FP have been described in cats and dogs (Etzioni et al., 2020; Grant & Troy, 2014; Reichle et al., 2003) and as well in a 4‐month‐old foal (Jones et al., 1994).…”

A rare ureteral tumour, what we know from the human side

“…Dysuria, pyuria, polydipsia and pollakiuria were signs that were less commonly reported but still associated with the presence of a ureteral fibroepithelial polyp (Gozalo et al, 2006;Lam et al, 2003). Kim et al (2022) credit flank pain to be a byproduct of obstructive hydronephrosis.…”

“…The main diagnostic imaging used in identifying fibroepithelial polyps is succinctly summarised by Kim et al (2022) as intravenous urography (IVU), ultrasound, imputed tomography (CT) (with or without contrast), or retrograde pyelogram. Each of these modalities excels in highlighting different diagnostic views of the polyp, however, due to their non-specificity, ureteroscopy is essential for direct visualisation and biopsy of the tumour needed to make a definitive diagnosis (Kim et al, 2022). Ureteroscopy is likely the best option in horses as the other diagnostic techniques are not feasible in the horse.…”

“…Ureteral fibroepithelial polyps are rare, benign, mesodermal tumours that frequently occur in the proximal ureter (but can develop along any portion of the urinary tract) and are the most common type of rare benign tumour to form within the urinary tract (Kim et al., 2022). Most of the information we have on these masses comes from the human literature.…”