首例使用銩雷射剝離術作為多葉纖維上皮性息肉擬態腎盂輸尿管交界處阻塞的首選治療

¹張睿哲、¹陳思遠*、¹王大民、²余美靜、¹王敘涵、¹林國仁、¹林志德、¹潘柏諺、¹林晏頎

¹林口長庚紀念醫院 外科部 泌尿外科

²林口長庚紀念醫院 兒童內科部 兒童腎臟科

First Approach of Thulium Laser Ablation as the First Treatment for Multilobulated Fibroepithelial Polyps Mimicking Ureteropelvic Junction Obstruction

¹Ruei-Je Chang, ¹Sy-Yuan Chen*, ¹Ta-Min Wang, ²Mei-Ching Yu, ¹Hsu-Han Wang, ¹Kou-Jen Lin, ¹Chih-Te Lin, ¹Pai-Yen Pan, ¹Yen-Chi Lin

¹Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

²Division of Pediartric Nephrology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose

Fibroepithelial polyps, benign tumors originating from the urinary tract’s mesenchymal tissue, are rare. Endoscopic advancements in children have led to increased reports of diagnosing and treating these polyps. Despite this, fibroepithelial polyps in the upper urinary tract remain uncommon, accounting for only 0.5% of ureteropelvic junction obstruction (UPJO) cases in pediatric patients. With only about 60 cases previously documented, our report introduces a novel treatment approach for this rare condition.

Materials and Methods

An 11-year-old boy visited our clinic with chronic dysuria, frequent urination (including one episode of nocturia per night) lasting for several months, and denied experiencing hematuria. He also reported intermittent crampy upper abdominal pain, along with nausea and vomiting over the past three weeks. A renal ultrasound revealed severe left hydronephrosis, raising suspicion for Diel’s crisis. Diagnostic ureteroscopy confirmed left UPJO caused by broad-based, multilobulated fibroepithelial polyps. The patient was treated with flexible ureterorenoscopy and endoscopic ureterotomy using Thulium laser ablation (Figure 1). After three months, follow-up showed full resolution of symptoms, with no recurrence of hydronephrosis

Results

Fibroepithelial polyps may mimick UPJ obstruction in children, thought to have a congenital origin. Due to their rarity, established treatment guidelines are lacking, though endoscopic resection is considered the first-line approach. Previous studies indicate that Holmium laser polypectomy is effective for single, pedunculated polyps, while broad-based, multilobulated polyps often require pyeloplasty. In our case, we successfully pioneered the use of Thulium laser ablation to treat broad-based, multilobulated polyps, marking the first reported use of this technique.

Conclusions

In this case, we successfully treated left ureteral complex polyps with laser ablation, resulting in complete resolution. This outcome suggests that laser ablation could be a very promising therapeutic option for managing this rare condition.