Ureteropelvic Junction Obstruction by a Long Intraluminal Polyp and a Concurrent Crossing Vein in a Symptomatic...

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Medical Imaging

Background:

• Ureteropelvic junction (UPJ) obstruction can be intrinsic or extrinsic, with extrinsic causes typically presenting later in childhood with symptoms.
• Antenatal ultrasonography frequently detects intrinsic UPJ obstruction.
• Symptomatic presentation in older children often suggests extrinsic causes or less common intrinsic pathologies.

Observation:

• An 8-year-old boy presented with acute severe left flank pain and grade 3 hydronephrosis on ultrasonography.
• No signs of infection were present.
• Diagnostic imaging revealed significant left hydronephrosis.

Findings:

• Laparoscopic dismembered pyeloplasty identified the cause as a large fibroepithelial polyp in the proximal ureter.
• An anterior crossing vein was also noted, potentially contributing to the obstruction.
• This case represents a rare cause of UPJ obstruction in a pediatric patient.

Implications:

• Fibroepithelial polyps are an uncommon but significant cause of ureteropelvic junction obstruction in children.
• This case underscores the need for thorough intraoperative evaluation to identify all contributing factors, such as crossing vessels.
• Successful laparoscopic management demonstrates the efficacy of minimally invasive techniques for complex UPJ obstruction.