Pediatric Surgery, Al Azher University, Cairo, Egypt
Urethral polyps are rare congenital lesions; and occurs almost exclusively in males, very rarely polyps in prepubertal girls and women arise from prolapsing urothelium that has evolved into a polyp, they usually arise from the verumontanum (posterior urethral polyp); and it may be piping out into the bladder neck, causing bladder outlet obstruction. An anterior urethral polyp is extremely rare and arises in the membranous or penile urethra. It produces the same symptoms and has the same morphology as a posterior polyp, few cases of peduculated urethral polyps arise from the distal urethra and protruded outside the meatus had been reported.
KeywordsUrethral polypsPolypoid urethritisProstatic urethral polypsFibroepithelial polypsUrethral caruncle
Polypoid urethritis, prostatic urethral polyps, fibroepithelial polyps of the urethra.
Urethral polyps are a rare anomaly of the male urethra. The exact incidence is not known but it has been on the increase in the last 20 years owing to better diagnostic techniques . Patients usually come to clinical attention between the ages of 3 and 9 years but may rarely present during infancy or adulthood (Fig. 32.1)
Urethral polyp with long pedicle, obviously seen coming from the urinary meatus in a hypospadiac child
The aetiology of urethral polyps is still controversial, congenital, infective, irritative, traumatic and obstructive causes have been proposed. The presence of a large polyp in healthy newborns and infants is a strong argument in favour of congenital origin . They may arise as a result of developmental error in the invagination process of the glandular material of the inner zone of the prostate. Morphologically, congenital urethral polyp is covered by urothelium that may be inflamed or ulcerated or exhibit squamous metaplasia. This differs from the more common prostatic urethral polyp occurring in adults that is covered by prostatic epithelium. The subepithelial stroma consists of loose fibrous tissue that may be highly vascular and may contain a few fascicles of smooth muscle .
With the increased incidence of hypospadias, and a subsequent merge of rare complications after its repair, we detect a case of urethral polyp as an outgrowth from the new urethra and it may be due to chronic irritation. (Fig. 32.2)
A small urethral polyp at the tip of a repaired urethra complicating hypospadias surgery
Signs and symptoms include hematuria, difficulty voiding, urinary retention, and infection These symptoms are similar to those of other obstructing urethral lesions, including urethral valve, stricture, and lithiasis. Physical examination is usually not helpful for diagnosis except for larger lesions that can be felt at rectal examination. Although ultrasound may pick up many cases of urethral polyp (Fig. 32.3), but the definitive diagnosis can be gained with cystourethrography or endoscopy, CT scan and MRI rarely indicated to diagnose such anomaly.