Urethral polyp is a benign neoplasm of a rounded shape on the leg, emanating from the epithelial layer of the urethra wall. It is clinically manifested by pain, burning in the urethra, a feeling of mechanical obstruction during urination, sometimes ‒ bloody or purulent discharge, acute urinary retention. It is diagnosed by examination and palpation of the genitals. If a urethral polyp is suspected, but it is not in line of sight, urethroscopy, ultrasound, urethrography are performed. Treatment is mainly surgical: transurethral resection, cryodestruction, radio wave excision, electrocoagulation.
ICD 10
D30.4 D41.3
Meaning
Polyps are the second most common (after papillomas) benign neoplasms of the urethra in male patients and the most frequent in women. According to statistics, about 4% of all urological patients, or 400 people per 10,000 population, turn to doctors with this pathology. With age, the risk of morbidity increases. The peak occurs at 55-60 years, which is facilitated by urogenital infections (chlamydia, mycoplasmosis), deterioration of blood supply to the urethral wall with genital atrophy. The occurrence of polyps in women is 1.5 times higher due to the peculiarities of the anatomy of the female urinary system and the general tendency to develop epithelial tumors, especially against the background of hormonal disorders after menopause.
Causes
The main mechanism of development of urethral neoplasms is increased proliferation of mucosal cells, which occurs as a response to the effects of damaging agents. The provoking factors of the formation of polypous growths are chronic stress, malnutrition, sleep disorders, bad habits. The main causes of polyps are:
- Damage to the urethra. Pathology develops under the influence of physical, mechanical factors. Damage to the urethra is possible as a result of operations on the genitourinary system or injury with concretions in urolithiasis, in gynecological practice — during termination of pregnancy, difficult childbirth complicated by rupture of the perineum of varying severity.
- Urinary tract infections. The infectious process is always accompanied by an inflammatory reaction, which leads to a decrease in the function of damaged cells. Mediators and components of inflammation enhance carcinogenesis, initiating the formation of tumor cells and increasing their survival, the ability to penetrate into neighboring tissues. The main infections that cause the formation of polyps include gonorrhea, chlamydia, mycoplasmosis, chronic urethritis of nonspecific etiology.
- Hormonal disorders. According to observations, persons with endocrine pathology (diabetes mellitus, hypothyroidism), menopausal women are more susceptible to the formation of benign tumors of the urethra. The postmenopausal state is characterized by a gradual decrease in the function of the female genital glands and a decrease in the production of estrogens, which have a stimulating effect on the antitumor immunity of the genitourinary system.
- Hereditary predisposition. There are areas in the human genetic apparatus responsible for normal cell division and differentiation. When the genes of these sites are mutated, the production of regulatory proteins of irregular structure is stimulated, which are unable to perform their functions to control the cell population. Pathological changes in the genome are transmitted to descendants, so the presence of urethral polyps in the anamnesis of parents increases the risk of morbidity in children.
Pathogenesis
At the moment, there is no consensus on the mechanisms of the development of polyps. Most often, the process manifests as a result of inflammatory, traumatic, trophic damage to the urethral mucosa against the background of a violation of humoral and cellular antitumor immunity. This leads to active tissue proliferation, a decrease in the degree of cell differentiation and their immunity to apoptosis (physiological death). Additionally, the relationship between the mucous membrane and the underlying layers of the urethra is disrupted, and the effectiveness of the regulatory mechanisms of the endocrine and nervous systems is also reduced.
The polyp tissue contains more actively dividing cells (up to 40%) than the usual one (5%), which causes the rapid growth of the neoplasm. With an increase in the tumor, the percentage of undifferentiated, genetically damaged cells increases, which under unfavorable conditions can lead to malignancy — the development of urethral cancer.
Classification
Urethral polyps are divided into several types depending on the etiology, quantity, and structure of tissues. Determining the type of polypous focus is an important point when choosing further therapy tactics. In men, polyps are usually localized in the distal part of the urethra or at the exit from it and represent a formation on a pedicle of no more than 0.5 mm in size. In women, tumors are more often formed on the back wall of the urethra, often spread to the tissues of the vagina and are large in size — from 1 to 10 mm. According to the type of cellular structure , there are 2 types of polyps:
- Fibrous. The tumor consists of dense connective tissue with a minimum number of vessels and glandular cells. More often it is a single formation that develops against the background of infectious, inflammatory processes or in violation of the trophic tissues of the urethra. There is a slow growth of the polyp, rare cases of germination into neighboring layers, a low risk of its malignancy. A subtype of fibrous polyp is the urethral caruncle in women, also consisting of elastic connective tissue, but well vascularized.
- Glandular. It is a nodular neoplasm consisting of glandular tissue, into which vessels abundantly germinate. Histological examination also reveals cysts ‒ cavities filled with serous fluid or secretions. The glandular polyp develops more often with hormonal imbalance, is characterized by rapid growth and a tendency to infiltrate the underlying layers of the urethra.
According to the etiology of the process that caused the formation of a pathological focus, inflammatory, neoplastic (from atypical cells), hyperplastic (due to the proliferation of healthy tissue) polyps are isolated. Regardless of the type of neoplasm, it is necessary to monitor its dynamic development. The risk of transition from a benign polyp to a malignant one always exists, especially with rapid growth and a large size of the tumor focus.
Urethral polyp symptoms
Benign tumors of the urethra, including polyps, develop more often after 45 years. In the initial period, the manifestations are completely absent or insignificant: there is a slight burning sensation when urinating, a feeling of incomplete emptying of the bladder. Often, patients mistake the symptoms for another disease of the genitourinary system with a similar clinic, for example, cystitis or urethritis. With an increase in the size of the polyp, the addition of inflammatory changes, the symptoms increase, which forces the patient to consult doctors.
The main signs of pathology are difficulty urinating, pain, burning in the urethra during sexual intercourse, when walking. Urinary incontinence may occur during coughing, sneezing, laughing, the appearance of blood when the tumor grows into the submucosal layers of the urethra. In the later stages, an infection may join, which, rising up the urinary tract, leads to pyelonephritis and the appearance of purulent discharge from the urethra.
The rapid growth of the neoplasm causes narrowing of the urethral lumen. Complete closure of the urethra leads to the development of acute urinary retention, characterized by severe cutting pains in the lower abdomen, a feeling of bursting of the bladder, symptoms of general malaise. The pathological condition requires immediate medical intervention – catheterization of the bladder, epicystostomy.
Complications
The main danger of a benign tumor process is its possible malignancy. The risk increases with hereditary predisposition, the presence of other tumor foci. Another complication is the development of chronic cystitis, urethritis or inflammatory kidney damage. The urethral polyp reduces the immunity of the urinary system, making it more susceptible to infections. The growth of the tumor into the vessels leads to a violation of the integrity of the mucosa and bleeding — hematuric syndrome. In men, the appearance of hematospermia (blood in the ejaculate) is possible. The long-term chronic nature of blood loss leads to the development of iron deficiency anemia.
Diagnostics
A small urethral polyp in the absence of a urological infection does not give pronounced symptoms, and the existing manifestations in the form of a slight pain or burning sensation in the urethra are nonspecific. It is detected by urologists or gynecologists accidentally at a preventive appointment or during an examination for another pathology with similar symptoms. Diagnosis of the urethral polyp includes:
- Objective examination. Anamnesis and existing complaints are collected, information about previously transferred diseases of the excretory system, identification of genetic predisposition, examination of the genitals. Visually and palpationally, the urethra polyp has a smooth surface, soft structure, pink color without dark areas.
- Laboratory methods. From general clinical studies, blood and urine tests are prescribed to detect signs of inflammatory processes in the body. Biomaterial is taken from the urethra and vagina, followed by bacteriological analysis. Histological examination of the tumor site (biopsy) helps to identify the type of polyp, distinguish a benign tumor from a malignant one.
- Ultrasound of the urinary system. A simple, safe, fast method of early diagnosis of urethral polyps. Detects tumors of the urethra and bladder due to their different echogenicity from healthy tissues, as well as the degree of blood supply. Ultrasound machines with the function of elastography additionally assess the microstructure of the neoplasm, which makes the study more accurate.
- Urinary tract endoscopy. Cystourethroscopy allows you to visually determine the state of the excretory tract, the bladder, to identify the presence of polyps, clearly visible against the background of an unchanged canal wall. It is also possible to take material for histological examination and perform simple therapeutic manipulations (removal of concretions, irrigation with antiseptics of foci of infection).
- X-ray. Urethrography is a modern research method in which the urethra is filled with a liquid or gaseous X-ray contrast substance. After a few minutes, a series of X-rays of the urethra is performed, allowing to assess the diameter of the lumen of its various departments and the presence of constrictions, the condition of the mucosa, the size and localization of neoplasms.
Differential diagnosis is carried out with chorionepithelioma, condylomas, solid chancre in syphilis, tuberculous focus, differing in cellular structure, etiology of tumor growth or a specific infectious agent. In difficult cases, pelvic MRI and CT with contrast are used for additional diagnosis of polyps.
Urethral polyp treatment
In the presence of concomitant diseases, small sizes of education without a pronounced clinical picture and the elderly age of the patient, treatment is limited to the observation and therapy of a local inflammatory process or correction of hormonal disorders. Surgical intervention is mandatory if the urethra polyp bleeds, prevents the discharge of urine, and grows rapidly. The main methods of operations are:
- Surgical removal. In surgical interventions for polyps, wedge-shaped excision of the neoplasm with a conventional scalpel is most often used within healthy tissues. The manipulation is performed under general anesthesia with subsequent suturing. If the tumor is located in a hard-to-reach place or at the base of the urethra, it is possible to use endoscopic techniques. In this way, mainly large (from 1 cm) or potentially malignant polyps are removed.
- Physical destruction. Several types of effects on polyp tissues are applied. With the radio wave method, the tumor is destroyed under the influence of high-frequency directional radio radiation, the effect of which leads to a thin tissue incision. Damaged vessels instantly coagulate and do not bleed. Radiowave removal is a modern painless method that does not leave scars and ensures rapid tissue recovery. Electrocoagulation, laser removal, cryodestruction of polyps are also used. These methods allow the use of local anesthesia, precisely adhere to the boundaries of the tumor, minimize damage to healthy tissues.
After surgery, the patient is fitted with a urinary catheter for two days so that the aggressive environment of urine does not damage the surgical wound and does not slow down regeneration. Excised polyp tissue is sent for histological examination to exclude malignancy of the tumor. The patient is incapacitated 4-5 days after surgery, after which he can fully return to work.
Prognosis and prevention
With complete, timely excision of the urethral polyp, the prognosis is favorable, the risk of relapse is minimal. The presence of signs of malignancy requires regular monitoring for several years. Preventive measures are primarily related to the intimate life of a person: it is necessary to exclude unprotected contacts with casual partners, but at the same time sexual life should be regular. It is important to observe personal hygiene, timely emptying of the bladder. It is recommended to have a preventive examination by a urologist or gynecologist every 6-12 months for early detection of a possible recurrence of the disease.
