Giant fibroepithelial polyp of the ureter presenting as acute obstructive pyelonephritis: a case report.

BACKGROUND: Ureteral fibroepithelial polyps are rare benign mesodermal tumors of the upper urinary tract that may mimic upper tract urothelial carcinoma. Their presentation with acute obstructive pyelonephritis is uncommon, and the optimal emergency-to-definitive treatment sequence is not well documented. This report describes a giant ureteral fibroepithelial polyp managed by urgent decompression followed by kidney-sparing ureteroscopic laser polypectomy.

CASE DESCRIPTION: A 28-year-old woman with no relevant medical or surgical history presented with left flank pain, hematuria, fever, chills, and renal colic. Computed tomography (CT) and clinical assessment supported a diagnosis of acute obstructive pyelonephritis secondary to a left ureteral polyp. Emergency percutaneous nephrostomy was performed, and antibiotic therapy was administered according to the antibiogram. After infection control, cystoscopy demonstrated a long, smooth, pink mass with necrotic areas protruding from the left ureteral orifice into the bladder. The initial specimen showed benign epithelial tissue with necrotizing inflammatory tissue. The patient subsequently underwent retrograde ureteroscopy and holmium laser polypectomy. The stalk was attached to the left ureter approximately 12 cm from the ureteral orifice, and the polyp occupied almost the entire ureteral lumen. Complete resection of the lesion, including its base, was achieved, and a double-J ureteral stent was placed. Final histopathology confirmed a benign ureteral fibroepithelial polyp composed of fibrovascular connective tissue covered by normal urothelium. The stent was removed after one month. At 3 months of follow-up, the patient had no complications and no evidence of recurrence.

CONCLUSIONS: Giant ureteral fibroepithelial polyps may mimic malignancy and may rarely present with acute obstructive pyelonephritis. Urgent decompression is required when infection and obstruction coexist. Retrograde ureteroscopy with laser polypectomy is a feasible minimally invasive diagnostic and therapeutic approach for selected benign ureteral fibroepithelial polyps.