A Rare Benign Mimic of Upper Uract Urothelial Carcinoma: Bilateral Renal Papillary Hypertrophy Presenting With Haematuria and Haematospermia

Introduction Renal papillary hypertrophy is a rare benign condition that can mimic upper tract urothelial carcinoma. Only a few cases have been reported in the literature. Case Presentation We describe a 37‐year‐old man referred on a 2‐week–wait pathway with a 3‐week history of intermittent gross haematuria and haematospermia. He also reported lower urinary tract symptoms. Family history was positive for urological and other malignancies, and he was an active smoker. Investigations, including CT urography, revealed bilateral renal calyceal filling defects concerning for urothelial carcinoma. Bilateral diagnostic flexible ureteroscopy with selective biopsy demonstrated prominent, hypertrophied papillae arising from multiple calyces. Histology revealed normal urothelium with no evidence of malignancy. The patient was managed conservatively and has remained asymptomatic for 24 months. Discussion Renal papillary hypertrophy may present with haematuria or flank pain and can closely resemble upper tract malignancy on imaging. Endoscopic evaluation with or without biopsy is essential to establish the diagnosis and avoid unnecessary radical surgery. Most reported cases, including ours, were managed conservatively with good outcomes. Conclusion Renal papillary hypertrophy should be considered in the differential diagnosis of haematuria. Flexible ureteroscopy with direct visualisation, with selective biopsy where appropriate, remains the most reliable diagnostic approach.