Current management strategies of urachal anomalies in pediatric patients: A scoping review

Abstract

IntroductionManagement of urachal anomalies in pediatric patients has historically lacked a clear consensus between conservative and surgical management. We aimed to review and summarize the literature on the diagnosis, symptoms, and evolution in the management of urachal anomalies in pediatric patients.MethodsWe performed a scoping literature review of PubMed/Medline and WebOfScience from January 2000 to February 2022.Results32 publications were selected for inclusion in this analysis. 1,438 unique studies were identified with 32 studies meeting inclusion criteria. 15/32 studies discussed both conservative and surgical management, 14/32 studies discussed only surgical management outcomes, and 3/32 studies discussed diagnostic methods. The studies discussing conservative management supported the treatment of urachal anomalies with an initial conservative approach, which includes watchful waiting, repeated ultrasounds, lesion measurement, and antibiotic use. 5/32 of the included studies identified patients that were converted from conservative to surgical management with conversion rates ranging from 12.5% to 43.5% per study. 14/20 converted patients were identified to have a urachal cyst and 13/20 had a persistent infection.ConclusionsStrong evidence exists that supports initial conservative management over surgical management of pediatric urachal anomalies. However, predictive factors for determining which patients will require surgical management remain elusive. Treatment algorithms can potentially be developed once carefully developed prospective studies delineate statistically significant patient factors which necessitate surgical management over observation.

A large urachal cyst presenting with lower urinary tract symptoms and a falsely elevated post-void residual on bladder scan

“…There are currently two main management strategies for urachal anomalies: conservative management and surgery. 2 , 5 Conservative management includes antibiotics, repeated ultrasounds, and watchful waiting. Surgical management includes both open exploration and laparoscopic and robotic approaches.…”

“…Open surgical approaches are the most commonly reported and in the past were the gold standard, but laparoscopic and robotic approaches have been favored in more recent years and allow for faster recovery. 5 Literature currently supports initial conservative management in children under the age of 1 due to the possibility of spontaneous resolution and conservative management with antibiotics for infected urachal remnants in older children. 5 However, surgery is the definitive treatment and may be necessary for those presenting with recurrent infections despite medical management or non-infectious symptoms, as in our patient.…”

“… 5 Literature currently supports initial conservative management in children under the age of 1 due to the possibility of spontaneous resolution and conservative management with antibiotics for infected urachal remnants in older children. 5 However, surgery is the definitive treatment and may be necessary for those presenting with recurrent infections despite medical management or non-infectious symptoms, as in our patient. Parents should also be counseled on the risk of future malignancy if conservative management is chosen.…”