Fibroepithelial polyps are rare in the urinary tract (found in 0.5% of all paediatric pyeloplasties and 5% of all cases of paediatric ureteral obstruction). The advent of ureteroscopy in paediatrics has increased the identification and treatment of these. This paper retrospectively reviews 123 patients (0-17 years) undergoing paediatric pyeloplasties, and identifies four cases of pelviureteric junction obstruction (PUJO) associated with polyps. Three out of four were left sided, one was bilateral, and all patients were male. Intraoperative pyelography identified four out of the five affected ureters. Polyp mapping was carried out using ureterenoscopy in those where the pyelogram identified the polyps. Laser polypectomy was carried out in two patients. One patient had the unidentified polyp excised at time of pyeloplasty. One patient with giant bilateral polyps underwent staged pyeloplasties incorporating the polyps in the resection. Polyps were either slender and cylindrical or broad based multilobulated. Follow-up was 6-18 months and all patients were well. The authors propose a treatment algorithm that includes a retrograde pyelogram on all patients undergoing a pyeloplasty and then ureteroscopy if there are positive filling defects. Treatment of the polyps may then occur using the laser or carrying out the concomitant pyeloplasty.
A new treatment algorithm for ureteral fibroepithelial polyps in children
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