Multiple metachronous fibroepithelial polyps in children.
OBJECTIVE
We present our experience with a new phenotype of fibroepithelial polyps recurring in the urinary tract in children after robotic or laparoscopic pyeloplasty, and discuss the most appropriate treatment for these multiple metachronous neoplasms.


METHODS
At our institution 14 children had fibroepithelial polyps as the cause of ureteropelvic junction obstruction at pyeloplasty. Of the patients 12 had at least 1 additional polyp in the ureter, necessitating concomitant ureteroscopy at either robotic or laparoscopic pyeloplasty. Of these 12 patients 9 had followup of at least 1 year.


RESULTS
In 6 patients with at least 1 year of followup neoplasms were seen on retrograde pyelography and ureteroscopy that were not present on ureteroscopy at pyeloplasty. At 6 months after stent removal following the first recurrence 2 patients (33%) showed a second recurrence on imaging at a different location in the upper tract requiring laser ablation. One of these patients had a third recurrence that required further intervention before all were disease-free. No major intraoperative or preoperative complications developed.


CONCLUSIONS
We should always consider the possibility of recurrent fibroepithelial polyps in children with ureteropelvic junction obstruction, and recommend routine retrograde pyelography and ureteroscopy at stent removal after laparoscopic or robotic pyeloplasty. Although ureteroscopic management seems to be the most appropriate modality in children with multiple metachronous fibroepithelial polyps, larger studies are needed.
Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Yoshiyuki
Y
Kojima
Sarah M
SM
Lambert
Brian L
BL
Steixner
Nicholas
N
Laryngakis
Pasquale
P
Casale
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007682:Kidney Pelvis; D008297:Male; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000601:surgery; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000601:surgery