Ureteric fibroepithelial polyps in children: Retrospective study and systematic review of a rare urological presentation.

Background: Fibroepithelial polyps are rare, benign lesions of mesodermal origin that have been reported in the genitourinary, oral, auditory and respiratory systems. Ureteric fibroepithelial polyps are extremely rare, with less than 200 cases reported in children over the past 20 years. The purpose of this study is to present a retrospective study and systematic literature review of children with fibroepithelial polyps. Furthermore, to present an algorithm for the investigation and management of children with suspected ureteric, fibroepithelial polyps.

Methods: A retrospective review of seven children with upper tract fibroepithelial polyps managed at two centres was conducted. A systematic review of all seven original articles reporting upper tract, fibroepithelial polyps in children was performed from January 2003 to November 2023.

Results: Seven children with a median age of 12 years (range 5.5-14 years) were managed with ureteric fibroepithelial polyps. The majority were male (n = 6/7) and left sided (n = 5/6). The most common presenting features were pain and haematuria. Three out of seven children had a long history of symptoms (range two to ten years). Diagnosis was challenging with numerous imaging studies required including: ultrasound, cross sectional imaging, functional studies and operative retrograde pyelogram/ureteroscopy. The majority were managed with laparoscopic pyeloplasty (n = 6/7) with one case converted to open. The systematic literature review revealed a total of 134 children. There was a male predominance (93 %) and 84 % of polyps were left sided. Numerous operative approaches were reported. There was one case of urothelial papilloma on histology with the remainder being benign fibroepithelial polyps.

Conclusions: Ureteric fibroepithelial polyps are a rare pathology typically seen in males and on the left side. Diagnosis can be challenging. Various management options have been reported depending on surgeon experience, size and location of the polyp.