==== Front Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2007.52asm-1-52LettersA case of urinary bladder benign polyp treated successfully by resection in a child Murshidi Mujalli S. Akl Kamal Correspondence: Dr. Muhalli S. Murshidi, Department of Urology, Jordan University Hospital, P.O. Box 13245, Amman 11942, Jordan, mujalli_mhailan@hotmail.comJan-Feb 2007 27 1 52 52 Copyright © 2007, Annals of Saudi Medicine2007This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. ==== Body To the Editor: We report a case of a 3-year old boy that presented with recurrent urine retention secondary to a bladder polyp. Acute urine retention is not common in children. It may be secondary to dysuria whether from urinary tract infection, vaginitis, meatal ulcer, severe constipation with fecal masses compressing the bladder neck, voiding dysfunction, or from medications such as sympathomimetics.1 Urethral obstructive lesions such as valves or stones may present with acute urine retention. Bladder polyps, however, are a very rare cause of acute urine retention in children. The boy was admitted to the Jordan University Hospital with recurrent acute urine retention and painless gross hematuria of 1-weeks duration. There was a history of urinary frequency, urgency, and suprapubic pain of 2 weeks duration. There was no history of a urine catheter. Physical examination was noncontributory. Urine analysis and culture were negative. A 24-hour urine collection revealed hyperoxaluria. A renal ultrasound was negative. The patient underwent urethrocystoscopy. There was a mobile greenish soft polypoid pedunculated mass measuring 1.2×0.6×0.5 cm in the bladder dome that was resected. Histopathology revealed an infarcted polyp with polypoid fibrovascular tissue lined by a transitional epithelium lacking nuclear atypia. The stroma was edematous and congested with scanty inflammatory cell infiltrates. There was no evidence of malignancy. The patient had one recurrence of the gross hematuria without recurrence of the polyp as demonstrated on repeat cystoscopy. He was put on pyridoxine for the hyperoxaluria. Recurrent urine retention in children may result from a variety of causes. However, bladder polyps as a cause are rare. Genitourinary tract polyps can occur anywhere from the renal pelvis to the urethra.2–5 Bladder polyps are rare in both adults and children. They may present with gross hematuria, voiding dysfunction,6 or urine infection.7–10 One should always keep in mind malignant tumours such as rhabdomyosarcoma, which may present in a similar manner. Diagnosis is by histopathology. Polyps are usually benign and do not turn malignant or recur. Al Ahmadie and colleagues reported a giant fibroepithelial polyp in a 3-year old child.11 In our patient, the location of the polyp allowed it to act as an intermittent valve, leading to urine retention alternating with symptom-free periods. The pathogenesis of bladder genitourinary polyps remains to be elucidated. One hypothesis suggests that stone-initiated chronic irritation of the genitourinary mucosa leads to polyp formation.5 The role of the stone and crystalluria in the initiation of the localized inflammatory trigger seems appealing. Murshidi proposed that chronic localized lamina propria edema may cause a mucosal bulge which culminates into a polyp,5 but this does not explain the presence of congenital polyps. In our patient, the chronic mucosal irritation with oxalate crystal may have contributed to localized edema and polyp formation. ==== Refs REFERENCES 1 Gatti JM Perez-Brayfield M Kirsch AJ Acute urinary retention in children Urology 2001 3 165 918 921 2 Aita GA Begliomini H Mattos D Jr Fibroepithelial polyp of the urethra Int Braz J Urol 2005 Mar-Apr 31 2 155 6 15877837 3 Beluffi Berton F Gola G Urethral polyp in a 1 month old child Pediatr Radiol 2005 7 35 7 691 3 15761771 4 Murshidi MS Fibroepithelial polyp of renal pelvis: Literature review and case report Dirasat 1985 10 XII 10 163 69 5 Murshidi MS Calculous disease and its relationship to fibroepithelial polyps of the renal pelvis and ureter Acta Urol Belg 1988 56 1 47 54 3364320 6 Gleason E Kramer SA Genitourinary polyps in children Urology 1994 7 44 1 106 109 8042248 7 Defoor W Minevich E Sheldon C Unusual bladder masses in children Urology 2002 11 60 5 911 8 Waisman SS Banko J Cromie WJ Single polypoid cystitis cystica and glandularis presenting as benign bladder tumour Urology 1990 10 36 4 364 6 2219622 9 Tsuzuki T Epstein JI Fibroepithelial polyp of the lower urinary tract in adults Am J Surg Pathol 2005 4 29 4 460 6 15767798 10 Fathi K Azmy A Howatson A Congenital posterior urethral polyps in childhood A case report Eur J Pediatr Surg 2004 6 14 3 215 7 15211417 11 Al Ahmadie H Gomez AM Trane N Giant botryoid fibroepithelial polyp of the bladder with myofibroblastic stroma and cystitis cystica et glandularis Pediatr Dev Pathol 2003 Mar-Apr 6 2 179 81 12574920 12 Dalens B Vanneuville G Vincent L Congenital polyp of the posterior urethra and vesical calculus in a boy J Urol 1982 128 5 1034 5 7176029