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Management of lower urinary tract fibroepithelial polyps in children
Sybille Rousseau1, Matthieu Peycelon2, Céline Grosos1
1Service de chirurgie pédiatrique, Hôpital Mère-Enfant, Centre Hospitalier Universitaire de Limoges, 8 Avenue Dominique Larrey 87042, Limoges, France.
Insights
Fibroepithelial polyps (FEP) are rare in children but manageable with endoscopic resection. This study highlights sonography as a key diagnostic tool, with no recurrences or complications observed in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Pathology
Background:
- Fibroepithelial polyps (FEP) of the lower urinary tract are uncommon in pediatric populations, with limited case reports available.
- Understanding the management of FEP in children is crucial due to its rarity and potential for urinary obstruction.
Purpose of the Study:
- To investigate the clinical experience and management strategies for pediatric fibroepithelial polyps (FEP) of the lower urinary tract.
- To evaluate the diagnostic and therapeutic outcomes of FEP in a pediatric cohort.
Main Methods:
- A retrospective multicenter review of 33 children diagnosed with lower urinary tract FEP between 2008 and 2018.
- Data collected included demographics, imaging, surgical procedures, and pathological findings from 13 pediatric surgery centers.
Main Results:
- Hematuria, acute urinary retention, dysuria, and urinary infections were the most frequent presentations.
- Ultrasound was the primary diagnostic imaging modality, often supplemented by MRI, cystourethrography, CT, or cystoscopy.
- Endoscopic resection was the predominant treatment, with a short median hospital stay and no reported recurrences or complications post-treatment.
Conclusions:
- Sonography is recommended as the initial diagnostic tool for pediatric lower urinary tract FEP, guiding subsequent endoscopic resection.
- Fibroepithelial polyps in children are confirmed to have a benign nature, with excellent outcomes and no recurrence following appropriate management.
Introduction:
Fibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date.
Objective:
The aim of this study was to address the experience of FEP management in children.
Study Design:
A retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed.
Results:
A total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1-48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1-10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1-34) months.
Discussion:
The main limitation of our study is the retrospective design, although it is the largest one for this pathology.
Conclusion:
This series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences.
Level Of Evidence:
Level V.
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