輸尿管纖維上皮息肉:案例報告

張哲睿¹、張一勤²、邱逸淳^3,4,5,6、張彰琦^1,3,*

¹臺北市立聯合醫院忠孝院區外科部泌尿科; ²臺北市立聯合醫院忠孝院區病理科; ³國立陽明交通大學醫學院醫學系泌尿學科; ⁴國立陽明交通大學書田泌尿研究中心; ⁵台北大學運動健康科學系; ⁶臺北市立聯合醫院陽明院區外科部泌尿科

Ureteral fibroepithelial polyp: a case report

Che-Jui Chang¹, Yi-Chin Chang², Yi-Chun Chiu^3,4,5,6, Chang-Chi Chang^1,3,*

¹Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.

²Department of Pathology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.

³Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

⁴Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.

⁵Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan.

⁶Division of Urology, Department of Surgery, Taipei City Hospital, Yangming Branch, Taipei, Taiwan.

Introduction:

A ureteral fibroepithelial polyp (UFP) is a rare benign tumor that develops in the urinary tract, with an unclear etiology. Patients with UFP commonly present with hematuria and flank pain due to obstructive hydronephrosis and urinary tract infection, though cases are rare and typically reported as single instances or in small series. Therefore, standardized treatment guidelines remain limited. In this case report, we discuss a 64-year-old man with a UFP, detailing his clinical presentation, diagnostic workup, and therapeutic approach.

Case presentation:

A 64-year-old Taiwanese man presented to the urology outpatient department with a history of difficulty in urination and intermittent gross hematuria persisting for several years. He reported symptoms including urinary frequency, urge incontinence, nocturia (once per night), and a weak urinary stream requiring straining to void. He denied fever, dysuria, flank pain, poor appetite, night sweats, or unexplained weight loss.

The patient's medical history was unremarkable for systemic diseases or malignancies, and he had no history of smoking or exposure to chemicals or radiation. Additionally, there was no family history of cancer. Physical examination revealed no abdominal or flank tenderness and no palpable masses. Digital rectal examination indicated an enlarged prostate with a nodule over the left lobe near the apex.

Urinalysis showed no evidence of pyuria, hematuria, or bacteriuria, while uroflowmetry demonstrated an obstructive pattern. Transrectal ultrasound confirmed prostatic enlargement (47 grams), and renal sonography showed no hydronephrosis. The patient’s prostate-specific antigen (PSA) level was elevated at 7.91 ng/mL. With an initial diagnosis of enlarged prostate with lower urinary tract symptoms (LUTS) and suspected prostate cancer, the patient elected to undergo greenlight photoselective vaporization of the prostate and a transrectal ultrasound-guided biopsy.

During the procedure, cystoscopy revealed a long, polyp-like tumor extending from the right ureteral orifice (Figure 1). Ureteroscopy was subsequently performed, and the tumor was resected by cutting the attached stalk of the polyp into the ureter using holmium:yttrium aluminium garnet (YAG) laser (0.3 J, 30 Hz) (Figure 2). A right upper third ureteral stricture was also identified, leading to the placement of a double-J stent, which was removed after a month. Histopathological examination of the excised tumor confirmed a fibroepithelial ureteral polyp lined by urothelium with edematous fibrovascular stroma, measuring 6.5 x 0.4 x 0.3 cm. A tissue biopsy of the resected ureteral wall showed fibrotic tissue and a concurrent biopsy of the prostate indicated benign prostatic hyperplasia.

Discussion:

UFPs are benign tumors of non-epithelial mesodermal origin, accounting for approximately 2–6% of all ureteral tumors. They typically affect individuals aged 20 to 40 but may occasionally appear in pediatric populations. Chronic irritation from allergies, trauma, stones, or infections is thought to contribute to UFP development. In pediatric cases, hormonal abnormalities or congenital disorders involving mesodermal development may play a role. UFPs often present with intermittent flank pain or discomfort due to obstructive hydronephrosis (79%) and hematuria (58%), with additional symptoms such as urinary tract infections, urinary retention, and frequency.

Multidetector CT is considered the preferred imaging modality for UFP diagnosis due to its high accuracy, though the radiologic appearance of UFPs can be non-specific. Differential diagnoses include urothelial carcinoma (UC), blood clots, or radiolucent urinary calculi. Ureteroscopy is instrumental in confirming UFP by allowing direct visualization and biopsy, which aids in excluding UC. Only two reported cases of UFPs have involved concurrent malignancies.

Endoscopic resection has become the preferred treatment for UFPs, especially in healthy patients with normal ipsilateral renal function. Studies report that ureteroscopic resection or fulguration with holmium

laser or electrocautery is effective and associated with a low incidence of ureteral strictures or recurrence. Ludwig et al. highlighted two cases of recurrence involving remnant or recurrent stones, a ureteral stricture, and a recurrent polyp in 7.0% of cases. Given the benign nature and recurrence pattern of UFPs, a follow-up protocol of CT-IVU at 3 months and ultrasound at 1 year is recommended.

Conclusion:
UFP is a rare entity with no established treatment or follow-up protocols. While imaging studies may not always provide a definitive diagnosis, endoscopy enables accurate identification and excision of UFPs. Endoscopic treatment offers an effective, minimally invasive approach for managing ureteral fibroepithelial polyps, as demonstrated in this case.