Kouranloo J.
Congenital Polyp of the Posterior Urethra and Bladder Stone in a 21 month old Boy.
Pak Paed J Jan ;26(4):203-5.

Congenital polyps of the posterior urethra are abnormal protrutions of the urethral floor in the area of veru montanum. Urethral polyps are rare in children. The usual signs and symptoms are intermittent obstruction, urinary tract infection, enuresis and vesical calculus. It is considered a non neoplastic congenital anomaly. Because of the obstructive potential it should be considered in the evaluation of young boys with lower urinary tract symptoms. The transvesical approach was used in this case to remove the polyp and stone.

Case Report: A 21 month old boy was admitted to Taleghani Medical Center in December 2000, with a history of blood smearing of his underwear and painful voiding with terminal dysuria. Several physical examinations failed to reveal abnormal findings. Dysuria persisted and multiple urinary tract infections occurred. Routine laboratory procedures did not reveal any abnormalities, apart from microscopic hematuria and urinary infection due to Proteus mirabilis. A film of the abdomen demonstrated a voluminous mixed density stone anterior to the internal meatus. His intravenus urogram demonstrated bilateral dilatation of the pelvocalycel system and the cystogram showed a mixed density rounded smooth filling defect just above the bladder neck. There were two other filling defects: one immediately above the bladder neck and another, with a stenotic area in the posterior urethra. Cystoscopy confirmed the diagnosis of a pedunculated polyp with a long stalk coming from the veru montanum with the head floating just above the internal meatus behind a calculus. Ultrasonography showed hydroureteronephrosis, posterior urethral dilatation, and a stone in the bladder. The lesion was approached through a transverse suprapublic incision at the tip of the polyp. The polyp could be seen extending into the bladder neck with its base arising posteriorly from the urethral floor just above the veru montanum. The stone and polyp were removed. The stone measured 18x12x9 mm and was composed of 65% calcium carbonate, 10% ammonium urate, 10% proteins, 5% monohydrate calcium oxalate and 10% ammonium magnesium phosphate. Histological findings included a fibro-epithelial polyp with external squamous metaplasia and edematous connective tissue. No cowper`s or aberrant prostatic gland was observed. At the one year follow-up, the boy was asymptomatic with no urological problems.

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