Endoscopic management of 10 separate fibroepithelial polyps arising in a single ureter.

INTRODUCTION: Fibroepithelial polyps of the ureter, usually of congenital or inflammatory origin, are rare entities. These polyps are often solitary, but cases of multiple polyps have also been reported. Treatment of these entities has evolved with emerging surgical techniques and technologies. SURGICAL TECHNIQUE: We describe our surgical technique for minimally invasive treatment of multiple polyps arising in a single ureter. The base of each polyp is ablated with a 365-microm holmium laser fiber operating at 10 W, and each polyp is removed from the ureteral wall with 3F grasping forceps. Hemostasis is achieved with laser coagulation. Ureteral stones are removed concurrently with a 2.4F basket. A 12/14F ureteral access sheath is used to facilitate the multiple passes of the ureteroscope and the removal of the polyps and stones from the proximal ureter. All 10 polyps were removed from the proximal portion of a single ureter. The ureteral stent was removed at 6 weeks, and follow-up intravenous urography at 6 months and ureteroscopy at 11 months showed no residual polyps or stones. The wall of the ureter was well healed, with no evidence of stricture.
CONCLUSIONS: We have demonstrated a specific minimally invasive technique that can be used to treat even highly complex cases involving upper urinary tract fibroepithelial polyps.