Pólipo fibroepitelial benigno de ureter distal / Benign distal ureteral fibroepithelial polyp

ABSTRACT

The authors present a rare case of benign fibroepithelial polyp at distal ureter. A nineteen-year-old man with macroscopic hematuria and no lumbar pain during the last three months presented to the urological clinic. The ultrasonography showed a polypoid lesion at the distal third of the left ureter, causing intermittent urinary obstruction at vesicoureteral junction. The intravenous pyelography showed a mobile filling defect following the ureteral peristalsis. The cistoscopy revealed a red polyp protruding through the ureteral meatus. The urinary cytology and biopsy are negative for malignancy. At surgery, a 10 cm polypoid lesion with a large pedicle (causing ureteral intussusseption) was noted 1.5 cm above the iliac vessels and passing through the left ureteral meatus. The patient was submitted to a left distal ureterectomy, with bladder cuff resection, ureteroneocistostomy with a Politano-Leadbetter technique and psoas hitch. The pathologic examination showed a benign fibroepithelial ureteral polyp. The patient was discharged on the sixth postoperative day, This is an interesting case due to the rare topography affected (commonly occurring at renal pelvis or superior ureter). The endoscopic resection of the lesion was not indicated due to the impossibility to achieve complete resection because of its large pedicle. In similar cases, a previous endoscopic biopsy is recommended to avoid an unnecessary nephroureterectomy, which is performed in up to 35 percent of the cases reported in literature