Adenomatous Polyp of the Verumontanum Causing Bladder Outlet Obstruction

A 27-year-old male presented with a history of gross hematuria with passage of clots. In addition to suprapubic pain with urination, he reported intermittency, urgency, frequency, and a sense of incomplete emptying. Valsalva or physical compression of his lower abdomen was necessary to pass urine. An outpatient intravenous pyelogram was negative, but retrograde urethrography demonstrated a filling defect at the base of the bladder (Figure 1). Flexible cystourethroscopy revealed a 3 cm pedunculated smooth polypoid mass arising from the verumontanum and projecting proximally into the bladder neck, causing a ball-valve effect. The patient underwent a transurethral resection of the mass. Histopathologic examination revealed a polypoid mass lined by a mixture of transitional and squamous epithelium composed of benign prostatic glands and stroma (Figure 2). The prostatic glands showed varying degrees of dilatation and hyperplasia and contained numerous corpora amylacea. Immunoperoxidase staining showed the epithelial cells of the glands to be strongly positive for prostate-specific antigen and prostatespecific acid phosphatase (Figure 3). Postoperatively the patient reported complete resolution of obstructive urinary symptoms as well as an increase in his ejaculatory volume. He has since experienced no recurrence of his symptoms.