The ‘Bladder Penis’: Longitudinal Polypoid Tumor of the Distal Ureter, a Rare Case of Urinary Tract Endometriosis

Background: Ureteral endometriosis presents a rare manifestation of endometriosis with approximately only 1% occurrence. Here we present an example of its strong pleomorphism with flank pain, obstruction and a large polypoid intravesical lesion originating from the distal ureter. Case: A 50-year-old woman was admitted with symptoms of acute flank pain, fever and signs of acute pyelonephritis. The patient was diagnosed as unilateral hydronephrosis of unknown origin and cytoscopy revealed an intravesical polypoid lesion with its origin from the distal ureter. Ureteroscopic resection of the polypoid tumor was performed and conservative management with ureteral stenting and hormone therapy for 6 months followed but failed. CT scan revealed ureteral fibrosis secondary to endometriosis. Consequently, ureterocystoneostomy was performed and complete relief of symptoms was accomplished. The post-operative excretory urography at 1 month showed no obstruction. No further episodes of pyelonephritis and flank pain have occurred during a 4 month follow-up. Conclusion: It appears that ureteral endometriosis is a highly pleomorphic disease capable of forming long tumor-like polypoid lesions. Surgical therapy in combination with hormone ablation remains the current therapy of choice for the treatment of ureteral endometriosis.