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| Year : 1981 | Volume
: 27
| Issue : 2 | Page : 125-6 |
Posterior urethral polyp in a neonate.
Rao PL, Bhattacharya NC, Joshi VV, Pathak IC, Mitra SK
How to cite this article:
Rao P L, Bhattacharya N C, Joshi V V, Pathak I C, Mitra S K. Posterior urethral polyp in a neonate. J Postgrad Med 1981;27:125 |
Congenital urethral polyp is a rare clinical entity presenting with varied clinical manifestations like urinary tract infection, hematuria and obstructive. uropathy. Since the description of the condition in human beings by Thompson in 1855, only a few cases numbering 37 were reported in the literature.[1], [3] Almost all are isolated case reports. In the review of 30 cases in 1970, Downs[5] showed that the average age of these patients with urethral polyp was 9.7 years. In the literature we could come across only one case report wherein the polyp was reported in a neonate of 3 weeks of age.[4] Herein, we are describing a 17 day old neonate, probably the youngest case in the literature with congenital urethral polyp.
Baby of P, a 17 day old, low birth weight, male baby born at home after full term, was brought to our emergency service with the history of hematuria of 48 hours' duration. Apparently well before, but for the low birth weight, the child started passing a few drops of blood before each act of micturition followed by clear urine, which lasted for 48 hours before the admission. The urinary stream was normal. On examination, the child looked toxic, and was dehydrated, had a heart rate of 80/min. and a respiratory rate of 30/min. The child also had spells of apnoea, lasting for 5 to 10 seconds. He had fine crepitations in both the lungs. The distended bladder was palpable per abdomen. The investigations revealed blood urea of 300 mg% with gross hyperkalemia. The child was put on intravenous fluids; antibiotics and blood transfusion was started. The child did not improve with these measures and died within 15 hours of admission. At autopsy, a small polyp arising from the junction of the bladder neck and the prostatic urethra, projecting into the internal urethral meatus was noted. The polyp measured 3 x 1.5 x 0.5 cm. The tip of the polyp appeared congested [Fig. 1]. The microscopic examination showed that the polyp was covered with stratified squamous epithelium and the core was composed of vascular loose connective tissue with focal myxoid areas [Fig. 2] on page 126A.
The rarity of the disease is illustrated by the fact that only 37 cases are reported in the last 130 years. In a series of 1500 cine micturating cystourethrograms, Gatewood[6] had one case of urethral polyp. There was only one neonate in the reported literature and our patient appears to be the youngest and the second neonate to be reported. In the review of 30 cases from the literature, the age of the patients ranged from 20 months to 54 years with an average age of 9.7 years.[5] Most of these cases presented with either urinary tract infection or obstructive uropathy. There were only 4 cases that presented with gross hematuria and no patient presented with such an advanced degree of obstructive uropathy as seen in this neonate. Most of these cases were diagnosed either by cysto-urethrogram or by endoscopy. Like our patient, there were only two cases where the diagnosis was made at autopsy.[2], [5] Most of the authors prefer a suprapubic transvesical approach to remove the polyp-especially in infants and younger children and a transurethral resection in adults and older children.[3], [5], [7] However, successful transurethral resection of the polyp also had been carried out in a neonate by Dewolf and Fraley.[4]
| 1. | Bagley, F. H. and Davidson, A. l.: Congenital urethral polyp in a child. Brit. J. Urol., 48: 278-283, 1976.  |
| 2. | Barrie, H. J. and Simms, D. C.: Hydronephrosis resulting from obstruction of the urethra by a polyp of the verumontanum. Amer. J. Clin. Path., 36: 356361, 1961. |
| 3. | Braun, E. W.: Congenital polyp of the prostatic urethra in a child. J. Urol., 114: 311-312, 1975. |
| 4. | Dewolf, W. C. and Fraley, E.: Congenital urethral polyp in the infant: case report and review of the literature. J. Urol., 109: 515-516, 1973. |
| 5. | Downs, R. A.: Congenital polyp of the prostatic urethra: A review of the literature and report of two cases. Brit. J. Urol., 42: 76-85, 1970. |
| 6. | Gatewood. O. M., Calhoun, R. L. and Levin, S.: Pedunculated polyp of posterior urethra. J. Urol., 97: 1052-1055, 1967. |
| 7. | Stueber, P. J. and Persky, L.: Solid tumour of the urethra and bladder neck. J. Urol., 102: 205-209, 1969. |
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