Robotic Excision of Large, Multi-focal Ureteral Fibroepipthelial Polyps

Ureteral fibroepithelial polyps (UFP) are benign neoplasms of mesodermal origin. In this report, we describe the rare presentation and robotic surgical management of UFP in an adult female. A 25-year-old female with recurrent bilateral UFP s/p multiple ureteroscopic ablations and right partial ureterectomy with ureto-ureteral anastomosis presented with left flank pain. Four-phase CT with delayed images demonstrated a filling defect in the left ureter. Ureteroscopy confirmed the left UFP. The number, size, and multifocality precluded endoscopic management. Creatinine was normal and the split function was 53%/47%. The patient was recommended for robotic repair. After mobilization of the colon, the ureter was identified and traced up to the hilum. There was an inflammatory rind surrounding the ureter through the majority of its length. Care was taken to avoid circumferential dissection of the ureter. Upon longitudinal incision of the ureter, polyps erupted with a release of hydronephrotic urine, despite pre-stenting. Polyps were transected at their base, revealing abnormal underlying urothelium. A ureteroscope was advanced through a robotic port to examine the proximal ureter and renal pelvis. The remaining polyps were removed after which a wire and stent were placed antegrade into the open distal ureter and proximally into the renal pelvis. The anastomosis was performed with 5-0 PDS. ICG and firefly confirmed suitable blood flow to the ureter. Pathology revealed benign fibroepithelial polyps with reactive changes to the urothelium. A retrograde pyelogram 2 months later revealed a patent ureter. This video demonstrates the successful robotic surgical management of large, multifocal UFPs.^1-5.