Introduction: Urethral polyps are a rare entity, and typically present in male patients being investigated for dysuria, hematuria, or urinary retention. The etiology of these benign tumours remains unclear; however, they are likely to arise from the verumontanum (mesonephric duct), or a remnant from the sinus tubercule (paramesonephric duct). We describe a novel surgical approach to a urethral polyp causing urinary retention in a newborn. Methods: A term baby (3815g) admitted to the neonatal intensive care unit with congenital diaphragmatic hernia and respiratory distress was found to be in urinary retention post operatively. Comorbidities included pulmonary hypertension, bilateral hydroceles, and ear dysmorphism with normal microarray and spinal ultrasound (US). A formal US demonstrated an avascular mass in the urethra, suspicious for a polyp with a distended bladder and no hydronephrosis. Voiding cystourethrogram (VCUG) revealed a well-defined pedunculated polyp protruding into the urethra with voiding, and no evidence of reflux. Surgical options that have been described include resection with cold knife, fulguration and more recently, laser ablation. Additionally, larger polyps not amendable to endoscopic removal may require a trans-vesical approach. Results: In the operating room, the ureteric orifices were orthotopic. The polyp was identified using a 6-French cystoscope just proximal of the verumontanum, with a well-defined stalk. Debris within the bladder suggested incomplete emptying. Given its large size and thin stalk, the polyp was resected in its entirety using a zero-tip loop-snare. Hemostasis was achieved with a monopolar fulgurating electrode. Pathology confirmed a benign urethral polyp. The baby was voiding well without urinary tract infections at follow up 6 weeks later, with no residual polyp or hydronephrosis on US. With this complete resection, prognosis remains excellent with recurrence unlikely. Conclusions: When suspected, the diagnosis of urethral polyps is achieved with VCUG and US, with ultimate endoscopic resection. We describe the successful endoscopic resection of a urethral polyp in a neonatal child with a loop snare, the first approach to our knowledge. This approach uses instruments readily available to the pediatric urologist and avoids the use of a resectoscope, and thus, the need for urethral dilatation in the newborn. SOURCE OF Funding: No funding
