Fibroepithelial urethral polyp causing complex urinary tract obstruction in a neonate: A rare case report and management

Abstract

Urethral polyps are rare benign lesions causing urinary tract obstruction in pediatric patients, predominantly affecting males. They arise from the posterior urethra in males and mid-urethra in females.

An 11-day-old male with antenatal hydronephrosis presented with UTI. Imaging revealed bilateral grade II hydronephrosis, distended bladder, and grade 5 bilateral vesicoureteral reflux. A fibroepithelial urethral polyp was identified and treated with bipolar resection.

Postoperative evaluation showed complete resolution of symptoms, emphasizing the importance of comprehensive urological evaluation in neonates with antenatal hydronephrosis.

1 Introduction

Urethral polyps represent a rare but clinically significant entity in pediatric urology, predominantly affecting male patients in early childhood or adolescence. The anatomical distribution of these benign fibroepithelial lesions demonstrates a predilection for specific urethral sites based on sex. In male patients, they predominantly arise from the posterior urethra, with the verumontanum being the most frequent point of origin. Conversely, in female patients, the mid-urethral region serves as the primary site of lesion development. These lesions can manifest with a spectrum of urinary symptoms ranging from subtle voiding difficulties to acute urinary retention. With an average presentation age of 5.2 years, these lesions pose unique diagnostic and therapeutic challenges. Clinical presentation may include hematuria, dysuria, recurrent urinary tract infections, or vesicoureteral reflux. Diagnosis typically involves a combination of voiding cystourethrography, which may reveal characteristic filling defects, and confirmatory cystourethroscopy. While generally solitary and congenital in nature, urethral polyps can occasionally be associated with more extensive urinary tract involvement. Management usually entails endoscopic transurethral resection, with excellent prognosis given their benign nature and lack of malignant potential. ^, This case report underscores the importance of considering rare anatomical anomalies in the differential diagnosis of pediatric urinary tract disorders, and the value of comprehensive, collaborative care for neonates with suspected urological issues.

2 Case presentation

We present the case of an 11-day-old male neonate with a significant history of antenatal hydronephrosis. The patient, born via spontaneous normal vaginal delivery (SNVD) at term, was admitted to the Neonatal Intensive Care Unit (NICU) with a urinary tract infection (UTI).

Physical examination revealed an uncircumcised neonate with both testes descended in the scrotum and a normal back exam. No congenital anomalies were noted.

Diagnostic Workup were intiated starting with post-natal renal ultrasound which revealed bilateral grade II hydronephrosis and a distended urinary bladder ( Fig. 1 A, 1 B, 1 C). Urinary catheterization was performed, and empiric antibiotic therapy was initiated.

Further evaluation with a micturating cystourethrogram (MCUG) demonstrated a smooth-walled urinary bladder, grade 5 bilateral vesicoureteral reflux, and a dilated posterior urethra, suggestive of possible urethral obstruction ( Fig. 2 A, 2 B, 2 C).

Given these findings, the patient was scheduled for cystoscopy. Preoperative Credé maneuver revealed a deviated urinary stream, further supporting the suspicion of urethral pathology ( Fig. 3 A). Postoperative Credé maneuver was done and it demonstrated a wide, patent urinary stream, indicating successful removal of the obstructing lesion ( Fig. 3 B).