Fibroepithelial polyps are rare benign mesenchymal tumors of the urinary tract. Although advancements in pediatric endoscopy have enhanced their detection and treatment, upper urinary tract involvement remains exceptionally uncommon—accounting for approximately 0.5% of pediatric ureteropelvic junction obstruction (UPJO) cases, with fewer than 60 cases documented. Clinical presentations are often vague, including flank pain, hematuria, or lower urinary tract symptoms, frequently mimicking more prevalent obstructive conditions. Due to their rarity, standardized treatment protocols are lacking. We present the first reported case of endoscopic management of a broad-based, multilobulated fibroepithelial polyp in the pediatric upper urinary tract using Thulium laser ablation, offering a novel, minimally invasive therapeutic option.

An 11-year-old boy presented with several months of dysuria, frequency, and nocturia, accompanied by intermittent crampy upper abdominal pain, nausea, and vomiting over the preceding three weeks. Renal ultrasonography showed significant left hydronephrosis. Ureteroscopy revealed broad-based, multilobulated fibroepithelial polyps causing left-sided UPJO. The patient underwent flexible ureterorenoscopy combined with Thulium laser endoscopic ureterotomy and targeted polyp ablation (Figure 1). Postoperative imaging at three months confirmed complete symptom resolution and normalization of the collecting system (Figure 2).

Though infrequent, fibroepithelial polyps are a relevant cause of pediatric UPJO and are presumed to be congenital in nature. Given the limited number of cases and lack of guidelines, endoscopic resection is generally preferred due to its minimal invasiveness. Holmium laser is commonly used for resecting narrow-based, pedunculated lesions, whereas complex, broad-based tumors have often necessitated open or laparoscopic pyeloplasty. Our experience demonstrates that Thulium laser offers a precise, tissue-preserving alternative for endoscopic treatment of complex polyps, successfully avoiding more invasive approaches.

Our findings demonstrate that Thulium laser ablation can be safely and effectively utilized to treat broad-based, multilobulated fibroepithelial polyps in the pediatric upper urinary tract. Unlike traditional management approaches—often requiring open or laparoscopic surgery for complex lesions—this case illustrates the feasibility of a fully endoscopic solution with excellent clinical and radiological outcomes. The precision and minimal thermal damage of the Thulium laser make it particularly suitable for delicate pediatric anatomy and complex soft tissue lesions. This successful outcome suggests that Thulium laser may expand the current indications for endoscopic management of congenital ureteral obstructions, providing a less invasive yet effective treatment alternative.

We report the world’s first successful application of Thulium laser ablation for treating a multilobulated, broad-based fibroepithelial polyp in a pediatric patient. This case supports Thulium laser as a viable, minimally invasive technique in selected cases of complex UPJO, potentially expanding the endoscopic armamentarium in pediatric urology.

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