Are bladder polyps (growth on the bladder wall) dangerous?

Are Bladder Polyps Dangerous?

Bladder polyps are generally benign lesions with excellent prognosis, but they require histopathologic evaluation to exclude the rare possibility of malignancy, particularly transitional cell carcinoma. The vast majority of urinary tract polyps are benign fibroepithelial polyps or inflammatory lesions, and endoscopic resection provides both diagnosis and cure with minimal recurrence risk 1.

Risk Stratification of Bladder Polyps

Benign Lesions (Most Common)

• Fibroepithelial polyps represent the most common bladder polyp type in adults, accounting for the majority of cases in large surgical series 1
• These are congenital lesions that can present at any age with hematuria, voiding difficulties, or urinary retention 2
• Inflammatory polyps including eosinophilic cystitis are benign reactive processes with no malignant potential 1
• Prostatic epithelial polyps can occur in the bladder and bladder neck, particularly in men over 45 years with concurrent benign prostatic hyperplasia, and are uniformly benign 3

Malignant Potential

• Transitional cell carcinoma can present as a bladder polyp in approximately 4-5% of cases (1 of 23 patients in one surgical series) 1
• The key distinguishing feature is that malignant polyps typically occur in patients with risk factors for bladder cancer
• In patients with bladder exstrophy who develop polyps, cystitis glandularis is associated with future adenocarcinoma risk and warrants long-term surveillance 4

Management Algorithm

Initial Evaluation

• All bladder polyps require endoscopic resection for both diagnosis and treatment, as imaging cannot reliably distinguish benign from malignant lesions 1, 3
• Cystoscopy with transurethral resection provides tissue diagnosis and is curative for benign lesions 1, 2
• Histopathologic examination is mandatory to exclude malignancy 1, 3

Post-Resection Outcomes

• Postoperative recovery is excellent with minimal complications in the vast majority of cases 1
• Mild perioperative hematuria occurs in approximately 8-10% of patients but resolves spontaneously 1
• Recurrence of benign polyps is rare during follow-up 1, 2

Surveillance Requirements

• Benign fibroepithelial polyps have potential for recurrence, necessitating long-term follow-up with periodic cystoscopy 2
• Patients with cystitis glandularis identified on pathology require ongoing surveillance with urine cytology and cystoscopy due to adenocarcinoma risk 4
• Patients with confirmed benign pathology and no recurrence at 1-5 years typically remain disease-free 3, 2

Critical Pitfalls to Avoid

Urethral Stricture Risk

• Approximately 8-10% of patients undergoing endoscopic resection of urethral or bladder neck polyps develop urethral stricture postoperatively 1
• These patients require repeated urethral dilations during follow-up 1
• This complication is more common with polyps at the bladder neck or prostatic urethra 2

Misdiagnosis Risk

• Bladder polyps are frequently misdiagnosed clinically as aggressive lesions based on imaging appearance alone 3
• Do not rely on clinical impression or imaging characteristics—histopathologic diagnosis is essential before determining prognosis 3
• Prostate-specific antigen immunohistochemical staining can help identify prostatic epithelial polyps and confirm their benign nature 3

Special Population: Bladder Exstrophy

• Polyps in exstrophic bladders show reactive squamous metaplasia in 50% of cases and cystitis glandularis in the majority of secondary closures 4
• These patients warrant lifelong surveillance as they enter adulthood due to increased malignancy risk 4