Imaging features of intravesical urachal cysts in children

Metwalli, Zeyad; Guillerman, R. Paul; Mehollin-Ray, Amy R.; Schlesinger, Alan E.

doi:10.1007/s00247-013-2628-y

Cited by 17 publications

(15 citation statements)

References 8 publications

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“…Congenital urachal remnants, urachal cysts in particular, are typically described as being external to the bladder. Nevertheless, there are reported instances in which these cysts, located at the anterosuperior aspect of the bladder, have appeared as intravesical lesions, ballooning into the bladder lumen or discharging intravesically (88). When infected, urachal cysts can appear with a hypervascular and heterogeneous echotexture at US and have variable enhancement at cross-sectional imaging (Fig 15).…”

Section: Inflammatory or Nonneoplastic Lesion Misinterpreted As A Tumormentioning

confidence: 99%

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

et al. 2017

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Urinary bladder masses are rare in children, and the associated histologic features and prognoses in this population are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. In general, pediatric bladder tumors can be divided into those that originate from the bladder epithelium, known as urothelial neoplasms, and mesenchymal bladder neoplasms, which are more prevalent. The most common bladder malignancy in children is a rhabdomyosarcoma, whereas the most common benign bladder lesion in the pediatric population is a papillary urothelial neoplasm of low malignant potential (PUNLMP). The first-line imaging tool for assessing bladder lesions is ultrasonography, which may be followed by a cross-sectional imaging examination such as computed tomography or magnetic resonance imaging if the origin of the mass is unclear or if distant spread is suspected. Although imaging may enable the radiologist to suggest a differential diagnosis based on lesion location and patient age, tissue biopsy generally is required to identify the exact pathologic entity. This is usually performed at cystoscopy and may be curative in cases in which the lesion is small and has low recurrence potential. Knowledge of the clinical, histopathologic, and imaging features of common bladder neoplasms is essential, as it can aid in preventing imaging pitfalls. These may include the misinterpretation of either a pelvic mass as arising from the bladder or a bladder mass as arising from the pelvis, and interpreting an inflammatory mass or bladder detritus as a neoplasm. RSNA, 2017.

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Section: Inflammatory or Nonneoplastic Lesion Misinterpreted As A Tumormentioning

confidence: 99%

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

et al. 2017

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“…There are still con icting opinions regarding therapeutic options for optimal UA management. Several authors suggest that asymptomatic incidentally diagnosed urachal anomalies are normal variants that don't need any intervention with a high chance for spontaneous resolution, regardless of UA type [2,7,8] . On the other hand, some argue that prophylactic surgery should be utilized in all patients in order to prevent progression to the symptomatic UA and further complications such as malignant transformation [5] .…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that urachal cyst is the most common type with 45% of cases, followed by urachal sinus with 37%, patent urachus in 16%, respectively [6] . There's no consensus about the urachal anomalies management approach [7,8] . Recent studies support the hypothesis that symptomatic and asymptomatic children will bene t from performing surgical excision with a bladder cuff because of the risk of malignant transformation [9] .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…It is composed of three layers: modified transitional epithelium, fibroconnective tissue and a layer of smooth muscle continuous with the detrusor 10. Failure of the obliteration of the allantois gives rise to rare abnormalities such as the formation of URs: complete patent urachus with free communication between bladder and umbilicus, persistent tissue at umbilicus with no connection to the bladder (umbilical polyp), persistent tissue at bladder with no connection to umbilicus resulting in bladder diverticulum, patent mid-duct with closure forming urachal cyst 11. A patent urachus is found in 1 in 200 000 live births and 1 in 5000 adults have an urachal cyst at autopsy 12.…”

Section: Discussionmentioning

confidence: 99%

Posterior urethral valves and urachal cyst: an unusual combination

2022

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Combination of posterior urethral valves and urachus remnants has been described as rare occurrence. We report a case of a baby boy with normal antenatal scans, in whom the presence of large urachal cyst and posterior urethral valves causing high pressure bladder and chronic kidney disease was found. The patient underwent ablation of posterior urethral valves at 23 days of life and urachal cyst removal at age of 4 and a half months.

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Imaging features of intravesical urachal cysts in children

Abstract: The purpose of this report is to expand the spectrum of urachal remnant anomalies to include these newly recognized intravesical urachal cysts, which are characterized on US by the presence of a thin-walled cyst along the midline anterosuperior aspect of the urinary bladder.

Cited by 17 publications

References 8 publications

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

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

Posterior urethral valves and urachal cyst: an unusual combination

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