Robotic Excision of Upper Ureteral Fibroepithelial Polyp Presenting as Pelviureteral Junction Obstruction: Surgical Surprise with Review of Literature

Abstract

Background: Fibroepithelial polyps in the upper ureter are a rare cause of pelviureteral junction obstruction (PUJO). Its diagnosis usually remains challenging by clinical and radiologic means. Case Presentation: We discuss a case of 19-year-old boy who present with intermittent left flank pain. Radiologic imaging suggested diagnosis of PUJO. We planned for robotic pyeloplasty. Intraoperatively pelviureteral junction (PUJ) was dependent, nonstenotic with upper hydroureteronephrosis creating suspicion of polyp. Keeping suspicion of polyp in upper ureter, we did robotic upper ureterotomy. This procedure revealed a 1 × 1 cm benign polyp at PUJ, which was excised completely. Conclusion: Polyps in the upper ureter constitute uncommon clinical cause of PUJO and usually diagnosed intraoperatively. Robotic approach is a feasible, acceptable, and safe option in such clinical scenario. It provides all the benefits of minimal invasive surgical procedures.