POLYP OF THE URETER
ibroepithelial polyps are the most common benign neoplasm of the ureter.‘,’ These lesions occur in men and women with equal frequency and have been reported in all age groups.’ Patients with fibroepithelial polyps commonly present with hematuria or flank pain. Intravenous urogram usually reveals a cylindrical ureteral filling defect.* Ureteroscopy allows identification of the typically smooth-surfaced fibroepithelial polyp and endoscopic resection allows the patient to avoid an open operation.* Our patient is a 24-year-old woman who presented with acute right renal colic, nausea and vomiting, and right costovertebral tenderness on physical examination. One year prior to presentation, she underwent ureteroscopic resection of a left ureteral fibroepithelial polyp. At that time, the stalk of the polyp was not clearly identified and resected. Laboratory studies demonstrated microhematuria and an elevated serum white blood cell count of 16,100/mm3. An intravenous urogram revealed delayed contrast excretion from the right kidney, a calcific density with a diameter of 1 mm in the right bony pelvis, and multiple cylindrical filling defects in the left side of the bladder (Fig. 1). The patient’s pain resolved with hydration and analgesics and a right ureteral stone passed spontaneously. Cystoscopic examination revealed rhythmic extrusion and withdrawal of tentaclelike projections into the bladder through the left ureteral orifice, confirming regrowth of the fibroepithelial polyp (Fig. 2). From the Department of Urology, The University of Iowa, Iowa City, Iowa Reprint requests: Christopher 5. Cooper, M.D., Department of Urology, The University ofIowa, 200 Hawkins Drive, 3120 RCP, Iowa City, IA 52242-l 089 Submitted: January 27, 1997, accepted (with revisions): March 10, 1997
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1. Intravenous urogram demonstrating filling defects in left side of the bladder.
The patient underwent an uneventful left ureterotomy and excision of an g-cm fibroepithelial polyp that stemmed from a single stalk (Fig. 3). At l-month follow-up, she was asymptomatic and had no evidence of disease on cystoscopy and retrograde ureteropyelograms. With complete resection of a fibroepithelial polyp at its base, regrowth is unlikely.3 Our patient demonstrates the need for, and at times the difficulty of, complete ureteroscopic resection. REFERENCES 1. Bolton D, Stoller ML, and Irby P III: Fibroepithelial ureteral polyps and urolithiasis. Urology 44: 582-587, 1994. 2. Muslumanoglu AY, Karaman MI, Ergenekon E, Semercioz A, and Sakiz D: A distal ureteral fibrous polyp and the role of ureteroscopic resection in its management. J Endourol 8: 199-201, 1994. 3. Oesterling JE, Liu HY, and Fishman EK: Keal-time, multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a distal ureleral fibroepithelial polyp and adjacenl calculus. J Urol 142: 15631566, 1989.
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