Prolapsing bladder neck polyp in a female: an innocuous pathology with unusual presentation
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IMAGES IN UROGYNECOLOGY
Prolapsing bladder neck polyp in a female: an innocuous pathology with unusual presentation Anuj Kumar Yadav 1 & Gopal Sharma 1 & Ravimohan S. Mavuduru 1 & Girdhar S. Bora 1 Received: 17 April 2020 / Accepted: 17 August 2020 # The International Urogynecological Association 2020
Keywords Female urethral polyp . Bladder outlet obstruction . Voiding dysfunction
Introduction Urethral polyps are a benign fibroepithelial hyperplasia and rare cause of voiding dysfunction in females leading to retention, bladder outlet obstruction, intermittency and haematuria. We report a rare case of a large urethral polyp in a woman leading to voiding dysfunction.
Case A 61-year-old woman presented to us with refractory urinary retention for 6 months. She had an indwelling catheter since then and had multiple failed trials of catheter removal. She had had obstructive voiding symptoms (straining at micturition and thinning of urinary stream) for the past 4 years prior to going into
* Girdhar S. Bora [email protected] Anuj Kumar Yadav [email protected] Gopal Sharma [email protected] Ravimohan S. Mavuduru [email protected] 1
Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
retention. She denied any history of previous surgery, medical illness or urethral instrumentation. On examination, she had a 16F Foley catheter in situ. Her routine blood investigations, urine culture and ultrasound of kidney and bladder were within normal limits. Urodynamic study was suggestive of high pressure and low-flow voiding (Fig. 1a). A voiding cystourethrogram was suggestive of multiple bladder diverticula and thinning of the urinary stream seen around the mid-urethra (Fig. 1b). On endoscopy a polyp was seen arising from the mucosa of the bladder neck, which was prolapsing into the urethra with gradual withdrawal of the cystoscope, thus leading to a flap-valve-like obstruction (Fig. 2). The polyp was resected transurethrally with a resectoscope (Fig. 3a). The catheter was removed the next day, the patient voided successfully, and the biopsy confirmed a benign polyp. At 3 months of follow-up, the patient was voiding with a good stream without straining. Uroflowmetry showed a good flow (Qmax = 19.7.7 ml/s) (Fig. 3b). Urethral pathologies such as polyps, urethritis, caruncles, diverticula and valves are commonly overlooked clinical entities [1]. Posterior urethral polyps or urethral prolapse is common past middle age in females and can lead to variable presentations such as urethral bleeding or voiding dysfunction [1]. Urethral polyps are commonly seen in childhood and are typically described as benign lesions lined with urothelium [2]. However, bladder neck polyp as a cause of acute urinary retention in an elderly female has never been reported to the best of our knowledge.
Int Urogynecol J Fig. 1 (a) Voiding phase of urodynamic study with the bladder filled up to 234 ml and detrusor pressure at maximum flow (Pdet Qmax) of 97 cm of water and maximum flow rate of 5.2 ml
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