Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 47, Num. 1, 2001, pp. 51

Journal of Postgraduate Medicine, Vol. 47, Issue 1, 2001 pp. 51

Prolapsing Anterior Urethral Polyp

Jiwane A, Kumar T, Kothari P, Kulkarni B

Department of Pediatric Surgery, L.T.M.M.C and G. Hospital, Sion (W), Mumbai - 400 022, India.

Code Number: jp01014

Case History

A 4-year-old boy presented with complaints of dysuria and something coming out of the external urethral meatus since the age of 1 year. He did not have any other urinary complaints.

Local examination revealed a single pedunculated polyp with a long stalk coming out of the meatal opening. The base of the stalk could not be seen. Haemogram was normal. Urine was sterile and urine microscopy did not reveal any abnormality. Anterior urethrogram did not reveal any associated polyps. Cystourethroscopy was done which ruled out multiple polyps. Under anaesthesia, the polyp was found to be arising from the floor of the glandular urethra. The polyp was excised and the base was ablated with diathermy. The postoperative course was uneventful. The histology of the excised polyp revealed it to be a fipoepithelial polyp. The polyp was covered by stratified squamous epithelium with wavy surface. Mild keratinisation was seen. The core showed fipous tissue, blood vessels and moderate inflammation. The child is asymptomatic on follow-up.

Discussion

John Hunter is credited with the first documented case of urethral polyp. Sir Henry Thompson reported the first case in a human. (1)

Urethral polyps are rare and anterior urethral polyps are even rarer. They are usually of congenital origin. Urethral polyps in children occur exclusively in boys; the average age is 5.2 years. Mostly they arise in the posterior urethra. Usually they arise proximal to the mempanous urethra. But, anterior urethral polyps are still very rare. They are usually single and rarely multiple.

The presentation of urethral polyps is as varied as dysuria, (2,3) retention, (2) secondary enuresis, (4) haematuria. (1) They may present with obstructive symptoms. (5) Occasionally, they present in adults with haematuria.1 Williams6 reported associated vesicoureteral reflux.

The diagnosis of anterior urethral polyps is by voiding cystourethrography and cystourethroscopy. (6) But, penile and bulbar urethra should be palpated in patients presenting with retention or dysuria. Indurated area or lump in the absence of radio-opaque stone on x-ray is suggestive of stricture or rarely a polyp.

The management of these polyps is usually by transurethral resection in adults. In children, open excision, urethral exploration and primary repair, or transvesical excision are done for posterior polyps. Anterior urethral polyps are treated by transurethral diathermy ablation.

The histological examination reveals a fipoepithelial core with transitional epithelium with squamous metaplasia at times.

References

1. Downs RA. Congenital polyps of the prostatic urethra. p J Urol 1970; 42,76-85.
2. Anandan N, Shetty SD, Patil KP, A.I.A.Ipahiml. Acute urinary retention caused by anterior urethral polyp. p J Urol 1992; 69:321-322.
3. Azmy AF. Anterior urethral polyp in a child. p J Urol 1990;66:323.
4. Redman JF. Anterior urethral polyp in a boy. J Urol 1982;128:1316.
5. Mirogen C, Ilhan A, Ozdiler E. Congenital urethral polyp in an adult. p J Urol 1998; 61:531-532.
6. Bagley FH, Davidson A I. Congenital urethral polyp in a child. p J Urol 1976; 48:278.

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