Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature

Abstract

Background: Surgery is the current mainstay for the treatment of urachal anomalies (UA). Recent literature data support the theory of a spontaneous resolution within the first year of life. The aim of this study, comprising solely surgically treated children, was to identify age specific patterns regarding symptoms and outcomes that may support the non-surgical treatment of UA. Methods: Retrospective review on the clinico-laboratory characteristics of 52 children aged < 17 years undergoing resection of symptomatic UA at our pediatric surgical unit during 2006–2017. Data was dichotomized into age > 1 (n = 17) versus < 1 year (n = 35), and complicated (pre-/post-surgical abscess formation or peritonitis, n = 10) versus non-complicated course (n = 42). Results: Children aged < 1 year comprised majority (67%) of cohort and had lower complication rates (p = 0.062). Complicated course at surgery exclusively occurred in patients aged > 1 year (p = 0.003). Additionally, complicated group was older (p = 0.018), displayed leukocytosis (p < 0.001) and higher frequencies regarding presence of abdominal pain (p = 0.008) and abdominal mass (p = 0.034) on admission. Regression analysis identified present abdominal pain (OR (95% CI), 11.121 (1.152–107.337); p = 0.037) and leukocytosis (1.435 (1.070–1.925); p = 0.016) being associated with complicated course. Conclusions: This study provides evidence that symptomatic disease course follows an age-dependent complication pattern with lower complication rates at age < 1 year. Larger, studies have to clarify, if waiting for spontaneous urachal obliteration during the first year of life comprises a reasonable alternative to surgery.

Preoperative imaging is essential for pathologically complete resection of the urachal remnant without unnecessary and excessive surgical invasion

“…However, a recent study showed that only one out of every 5721 UR cases leads to urachal adenocarcinoma [2]. Another study reported that conservative follow-up is an option for UR patients younger than 1 year [11,12] and for UR patients after undergoing initial drainage treatment [13]. Each individual pediatric patient with UR should be treated based on the imaging results.…”

Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study

“…However, a recent study showed that only one out of every 5721 cases of UR develop into urachal adenocarcinoma [ 2 ]. Another study reported that conservative follow-up is an option for patients with UR younger than 1 year [ 11 , 12 ] and for those undergoing initial drainage treatment [ 13 ]. Each individual pediatric patient with UR should be treated based on the imaging results.…”