Vol. 114, August
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyrip;ht © 1975 by The Williams & Wilkins Co.
CONGENITAL POLYP OF THE PROSTATIC URETHRA IN A CHILD EDWARD W. BRAUN* From the Urology Service, Naval Hospital, Orlando, Florida
ABSTRACT
are an uncommon cause of urethral The diagnosis is made trans urethral Congenital of the prostatic urethra are a rare cause of posterior urethral obstruction in boys. There are 35 cases of congenital urethral polyps previously reported in the literature. 1 Such a case is described herein. CASE REPORT
M. M., a 4-year-old white boy, was referred to this hospital because of an inability to void for 12 hours. Voiding efforts were accompanied by
der catheterization with a No. SF feeding tube yielded 300 cc amber urine and afforded immediate relief. Urinalysis revealed 8 to 14 white blood cells and 3 to 5 red blood cells per high power field. Urine culture yielded more than 100,000 colonies per cc Escherichia coli. Blood urea nitrogen was 10. The patient was initially treated with ampicillin and bladder drainage. An excretory urogram demonstrated normal kidneys and ureters. A voiding cystourethrogram revealed a space-occupying
Low power view of surgical specimen shows ulceration of transitional epithelium.
spasms of pain and penile erections. The patient was toilet trained without relapses when he was 2 years old and was of normal growth and development. During the last year several brief episodes of an inability to void occurred but resolved spontaneously at home. There was no history of dysuria or gross hematuria. On physical examination a tender suprapubic mass was palpated to the umbilicus. The rectal examination was normal. BladAccepted for publication February 21, 1975. The views represented herein are those of the author and do not constitute a statement of official Navy * Requests for reprints: rviercy Hospital, Fort Kansas 66701.
negative filling defect of smooth contour in the prostatic urethra. There was no vesicoureteral reflux. Cystoscopy revealed a polyp in the posterior urethra, which was attached to a long stalk anchored between the bladder neck and verumontanum. The polyp was observed to flip in and out of the bladder, and acted like a ball valve obstructing the prostatic urethra on antegrade urine flow. A biopsy was taken using an infant resectoscope. Histologic sections showed a benign polyp composed of a fibrovascular stroma with rare bundles of muscle and nerve. The polyp was covered transitional focal ulceration (see excision of
312
BRAUN
the urethral polyp was performed 2 days later. The large polyp was seen extending into the bladder and was resected at its origin from the base of the prostatic urethra. One week later the patient was discharged from the hospital and voiding well. At 6-month followup the urine was sterile and repeat cystoscopy revealed no evidence of recurrent posterior urethral polyp formation. DISCUSSION
Congenital urethral polyps probably represent a protrusion of the defective urethral wall rather than true neoplasia. The smooth muscle and nerve bundles found in this polyp suggest origin from the subepithelial connective tissue of the urethra. Of the 35 cases of posterior urethral polyps
previously reported, 11 were removed transurethrally and the remaining 24 were removed transvesically. The transvesical method seems to be the easier approach when dealing with a large polyp. However, if the transvesical approach is used, a transurethral biopsy is helpful in distinguishing the benign urethral polyp from a malignant lesion and, thus, prevents the unnecessary dissemination of tumor cells that would occur if a rhabdomyosarcoma were approached transvesically. 2 REFERENCES 1. DeWolf, W. C. and Fraley, E. E.: Congenital urethral
polyp in the infant: case report and review of the literature. J. Urol., 109: 515, 1973. 2. Williams, D. I.: Urology in Childhood. New York: Springer-Verlag, p. 316, 1974.
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyrip;ht © 1975 by The Williams & Wilkins Co.
CONGENITAL POLYP OF THE PROSTATIC URETHRA IN A CHILD EDWARD W. BRAUN* From the Urology Service, Naval Hospital, Orlando, Florida
ABSTRACT
are an uncommon cause of urethral The diagnosis is made trans urethral Congenital of the prostatic urethra are a rare cause of posterior urethral obstruction in boys. There are 35 cases of congenital urethral polyps previously reported in the literature. 1 Such a case is described herein. CASE REPORT
M. M., a 4-year-old white boy, was referred to this hospital because of an inability to void for 12 hours. Voiding efforts were accompanied by
der catheterization with a No. SF feeding tube yielded 300 cc amber urine and afforded immediate relief. Urinalysis revealed 8 to 14 white blood cells and 3 to 5 red blood cells per high power field. Urine culture yielded more than 100,000 colonies per cc Escherichia coli. Blood urea nitrogen was 10. The patient was initially treated with ampicillin and bladder drainage. An excretory urogram demonstrated normal kidneys and ureters. A voiding cystourethrogram revealed a space-occupying
Low power view of surgical specimen shows ulceration of transitional epithelium.
spasms of pain and penile erections. The patient was toilet trained without relapses when he was 2 years old and was of normal growth and development. During the last year several brief episodes of an inability to void occurred but resolved spontaneously at home. There was no history of dysuria or gross hematuria. On physical examination a tender suprapubic mass was palpated to the umbilicus. The rectal examination was normal. BladAccepted for publication February 21, 1975. The views represented herein are those of the author and do not constitute a statement of official Navy * Requests for reprints: rviercy Hospital, Fort Kansas 66701.
negative filling defect of smooth contour in the prostatic urethra. There was no vesicoureteral reflux. Cystoscopy revealed a polyp in the posterior urethra, which was attached to a long stalk anchored between the bladder neck and verumontanum. The polyp was observed to flip in and out of the bladder, and acted like a ball valve obstructing the prostatic urethra on antegrade urine flow. A biopsy was taken using an infant resectoscope. Histologic sections showed a benign polyp composed of a fibrovascular stroma with rare bundles of muscle and nerve. The polyp was covered transitional focal ulceration (see excision of
312
BRAUN
the urethral polyp was performed 2 days later. The large polyp was seen extending into the bladder and was resected at its origin from the base of the prostatic urethra. One week later the patient was discharged from the hospital and voiding well. At 6-month followup the urine was sterile and repeat cystoscopy revealed no evidence of recurrent posterior urethral polyp formation. DISCUSSION
Congenital urethral polyps probably represent a protrusion of the defective urethral wall rather than true neoplasia. The smooth muscle and nerve bundles found in this polyp suggest origin from the subepithelial connective tissue of the urethra. Of the 35 cases of posterior urethral polyps
previously reported, 11 were removed transurethrally and the remaining 24 were removed transvesically. The transvesical method seems to be the easier approach when dealing with a large polyp. However, if the transvesical approach is used, a transurethral biopsy is helpful in distinguishing the benign urethral polyp from a malignant lesion and, thus, prevents the unnecessary dissemination of tumor cells that would occur if a rhabdomyosarcoma were approached transvesically. 2 REFERENCES 1. DeWolf, W. C. and Fraley, E. E.: Congenital urethral
polyp in the infant: case report and review of the literature. J. Urol., 109: 515, 1973. 2. Williams, D. I.: Urology in Childhood. New York: Springer-Verlag, p. 316, 1974.
