Current management of the urachal anomalies (UA). Lessons learned from the clinical practice

Abstract

Purpose: It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the clinical presentation, the e cacy of current modalities used, and postoperative pathology in patients with UA.Material and Methods: We have performed a retrospective review of all patients diagnosed with UA and treated surgically or conservatively over 18 years. Demographic data, clinical presentation, imaging modalities, pathology, treatment, and postoperative complications were analyzed.Results: Twenty-ve symptomatic patients (18 males and seven females) with a median age of 13 years (one month to 37 years) were identi ed. 15 (60%) were diagnosed with a urachal cyst, 4(16%) with sinus, 3(12%) with urachal diverticulum, and the remaining 3(12%) with patent urachus.Of those, 20(80%) underwent surgical repair, and the remaining ve (20%) patients were managed conservatively. 4 (20%) underwent laparotomy, 7 (35%) laparoscopic incision, and the remaining 9 (45%) laparoscopic robotic-assisted surgery. Nine patients required bladder cuff excision. The median operative time was 75 minutes (42-140 min).One patient developed Clavien Dindo grade IIIA complication resulting in infected hematoma, which resolved after drainage. Another patient with a complication of grade IIIB needed reoperation as a result of recurrent events of an abscess. 13 (65%) demonstrated epithelium lining of the urachus on postoperative pathology. Conclusions: Our data show that most of the patients with UA presented with epithelial lining, which might lead to the later malignant transformation. It might cause a shift from the conservative management of asymptomatic patients to surgical intervention. Robotic-assisted surgery appears bene cial in these patients, especially when the bladder cuff excision is required.

Umbilical cord cysts: Classification, diagnosis, prognosis, and pregnancy recommendations

“…After birth, this may result in the urine from the bladder leaking out of the umbilicus, called urachal fistula. In addition, urachal cyst may still lead to rupture, secondary infection, sepsis, and fistula formation after birth or long after birth 48,49 . Therefore, for pediatricians, it is important to carefully examine the abdomen of newborns when UCC is detected prenatally, to help identify possible patent urachus early.…”

“…In addition, urachal cyst may still lead to rupture, secondary infection, sepsis, and fistula formation after birth or long after birth. 48,49 Therefore, for pediatricians, it is important to carefully examine the abdomen of newborns when UCC is detected prenatally, to help identify possible patent urachus early. If necessary, repair surgery should be performed without delay.…”