Printer Friendly

LARGE PROLAPSING URETHRAL POLYPS IN FEMALE CHILDREN: A REPORT OF TWO RARE CASES.

Byline: Naima Rasool C. Aqeel Safdar Asrar Ahmad and Shehla Kanwal

INTRODUCTION

Urethral polyps (UPs) are a rare entity in children1. In young girls these are even rarer complex and of heterogeneous variety2. Majority of male patients present with a protruding mass through the urethral meatus painless hematuria or obstructive voiding symptoms. In girls presenting features are vaginal" bleeding or an inter-labial mass3. Inter-labial mass may be of urethral vaginal or labial origin hence making diagnosis difficult. Investigations like ultrasonography or urography are needed to exclude other urinary tract anomalies. Resection is done endoscopically or transurethrally and recurrence is extremely rare3. We report two such cases of female babies who presented as inter- labial masses. UPs were excised with uneventful recovery. Histopathology confirmed the diagnosis of benign fibroepithelial polyp without any recurrence over a period of six months.

CASE REPORT CASE- 1

A female baby of 7 months was brought to ER with a painless bleeding mass protruding through labia for last one week. On examination a 3x2 cm red grape like polypoid mass was visible on separation of labia. Urethral and vaginal opening could not be identified separately in irritable and crying baby. Her base line investigations kidney functions ultrasound of lower abdomen and urinary tract were normal. On examination under anesthesia it was a bi- lobed polypoid mass connected with almost 2 cm long single stalk which was attached to the right margin of the distal urethral wall (fig 1). On cystoscopy no other lesion was found in urethra or bladder. This mass was excised after ligation of stalk with vicryl 4/0. Catheter was retained for 24 hours. Post operative recovery was uneventful. Histopathology report confirmed the suspicion of benign fibroepithelial polyp. No recurrence was noted at 6 months follow up.

CASE- 2

A 5 year old female was brought to outpatients' department with complaints of a bleeding mass at introitus". On inspection a small 2x2 cm purplish colored mass was visible on separation of labia. It was coming out of urethral meatus. Vaginal opening was visualized separately (fig-2). Blood complete picture renal profile and ultrasound KUB were normal. Cystoscopy was also normal. This was an almost sessile polyp attached to the superior wall of the urethral meatus. It was excised from the base and residual gap sutured. Foley's catheter was passed for 24 hrs. Histopathological report confirmed a benign fibroepithelial polyp. Child was well and free of any recurrence over 5 months follow up.

DISCUSSION

Only few cases are documented in English literature. In girls due to close proximity of vagina and short length of urethra there is an extensive spectrum of heterogeneous genitourinary lesions making the diagnosis and management confusing. The etiology is not exactly understood but it may be prolapsed urothelium of the bladder or urethra which may evolve into a urethral polyp3.

The presenting symptoms are variable. In boys it may present as obstructive urinary symptoms hematuria or a prolapsed mass at the meatus4. In girls the presentation is more complex. Mostly these present as inter-labial masses5. Less common presentations are vaginal" bleeding with no history of trauma or vulvitis. Other inter-labial masses should be considered while dealing with these patients6. Ultrasonography and urography are helpful in delineating the anatomy of urinary system and origin of polyps7. Cystourethroscopy is done for the differentiation and resection of UPs8.

Complete excision is mandatory to avoid recurrence.

In the first baby on EUA a bifid polypoid growth was found to be coming out of urethral meatus. The stalk of polyp was attached to the right wall of the proximal urethra. In the second baby polyp was found to be attached to the superior wall of the meatus transurethral excision was done in both cases. Urinary catheter was passed for 24 hours in both cases and both made uneventful recovery.

Histopathologically UPs are benign fibroepithelial masses composed of connective tissues vessels and covered by urothelium9. Histopathology in both of our patients confirmed the diagnosis of benign UPs. The prognosis is generally very good. Both the cases were free of recurrence uptill 5 months of follow up. REFERENCES

1. Carrion LP Dominguez HC Serrano DA Estornell MF Martinez VM Garcia IF. Congenital fibroepithelial polyps of the urethra. Cit Peadiatr 2010; 23:7-9. [From abstract only].

2. Kimura T Miyazato M Kawai S Hokama S Sugaya K Ogawa Y. Urethral polyp in a young girl: a case report. Hinyokika Kiyo 2007; 53: 657-9.

3. Ben-Meir D Yin M Chow CW Hutson JM. Urethral polyps in prepubertal girls. J Urol 2005; 174: 1443-4.

4. Sitapara A Popat S. Urethral polyp in neonate: a rare occurrence. J Paedatr Surg 2005; 40:73-4.

5. Klee LW Rink RC Gleason PE Ganesan GS Mitchell ME Heifetz SA .Urethral polyp presenting as interlabial mass in young girls. Urology 1993; 41:132-3.

6. Nussbaum AR Lebowitz RL Interlabial masses in little girls: review and imaging recommendations. AJR Am J Roentgenol 1983; 141:65-71.

7. Bourdelat D. Strangulated ureterocele and prolapsed urethral mucosa in a little girl. Diagnostic difficulties. Ann Urol 1986; 20:47-50.

8. Jan IA Anwer U Aasim S Ahmed S. Urethral Polyp in Children. J Coll Physicians Surg Pak 2000; 10:149-50.

9. Demircan M Ceran C Karaman A Uguralp S Mizrak B. Urethral polyps in children: a review of the literature and report of two cases. Int J Urol 2006; 13: 841-3.

10. Ceylan H Ozokutan BH KarakAlk M Buyukbese S. Paraurethral cyst: is conservative management always appropriate Eur J Peads Surg 2002; 12: 212-4.

11. Gleason PE Kramer SA. Genitourinary polyps in children .Urology1994; 44: 106-9.

12. Aita GA Begliomini H Mattos D Jr. Fibroepithelial polyp of the urethra. Int Braz J Urol 2005; 31: 155-6.
COPYRIGHT 2014 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Pakistan Armed Forces Medical Journal
Date:Sep 30, 2014
Words:945
Previous Article:REPORTING TIME OF ISCHEMIC STROKE PATIENTS WITHIN THE TIME WINDOW FOR THROMBOLYSIS IN A TERTIARY CARE HOSPITAL AT RAWALPINDI.
Next Article:EXPERIENCE OF PRIMARY AMOEBIC MENINGOENCEPHALITIS IN ICU PNS SHIFA KARACHI.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |