Trends in surgical management of urachal anomalies

Stopak, Joshua K.; Azarow, Kenneth S.; Abdessalam, Shahab; Raynor, Stephen C.; Perry, Deborah; Cusick, Robert A.

doi:10.1016/j.jpedsurg.2015.04.020

Cited by 31 publications

(22 citation statements)

References 29 publications

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“…Accordingly, in a retrospective study on repeated imaging in 103 patients with UA, Naidich et al observed a spontaneous resolution of UA in 15 patients out of 19 (79%, symptomatic n = 8, non-symptomatic n = 7) [ 4 ]. Finally, and also in line with previous reports, Stopak et al reported on a spontaneous resolution in 87% ( n = 13) of patients with conservatively monitored UA within about one year of diagnosis [ 12 ]. Moreover, patients aged below six months comprised 92% ( n = 12) of cases in which UA resolved with observation.…”

Section: Discussionsupporting

confidence: 88%

“…Moreover, patients aged below six months comprised 92% ( n = 12) of cases in which UA resolved with observation. Given these literature data, a delayed obliteration at age of six to twelve months of life might be considered physiological and surgical intervention should be reserved only for cases of multiple symptomatic episodes, visible umbilical urine drainage, peritonitis, or abscess formation [ 12 ]. Given our observed age-pattern with a pre-surgical complicated course exclusively observed in children older than one year and a trend towards elevated post-surgical complication rates in patients younger than one year, a conservative approach in children during their first year of life might be considered in line with a proposed conservative approach.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…True cord cysts are derived from the embryological remnants of the allantois, while pseudocysts arise from the liquefaction of Wharton’s jelly and lack an epithelial lining [ 16 ]. Furthermore, in the presence of a true cyst and patent urachus, some data recommend its conservative management in newborns [ 17 ]. Table 1 presents some studies on GUC from 2000.…”

Section: Discussionmentioning

confidence: 99%

Giant umbilical cord in a normal preterm infant: a case report and review of the literature

2023

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Background Giant umbilical cord, defined as a cord diameter of more than 5 cm, is an extremely rare malformation. There are few case reports of giant umbilical cord often associated with patent urachus duct or cystic malformation. These cases are usually managed by surgical excision and repair of patent urachus or cyst resection. Case presentation We report the case of a 1-day-old Iranian boy with giant umbilical cord detected postnatally. The pregnancy course was uneventful, except for preterm premature rupture of the membrane and preterm delivery. There was no relevant family history. The patient was delivered by vaginal delivery with a good Apgar score. On clinical examination, the umbilical cord was very thick (about 6 cm in diameter), and huge fluctuating Wharton’s jelly was observed. Other organs were normal. During the hospital stay, the patient did not develop any complications except borderline hyperbilirubinemia, which improved with conventional phototherapy. Since the umbilical cord had no discharge and was dried, the newborn was discharged with advice for cord drying care. Conclusion The newborn was well, and the dried umbilical stump was detached after 32 days, leaving a granulomatous structure without discharge. The patient was followed up for 4.5 months and had no problems except delayed separation of the umbilical cord.

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“…Interestingly, none of the cases were associated with lower urinary tract anomalies, leading us to question the need for invasive investigations in newborns. Furthermore, prospective data are beginning to emerge supporting conservative management of patent urachus in newborns 5. In summary, most GUCs appear to be harmless, associated with normal urinary tracts and hence may not warrant investigations and/or pre-emptive intervention in the newborn period in the absence of abnormalities in the urinary system on antenatal ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Management of the giant umbilical cord: challenging the need for investigations in the newborn

Young¹,

McGeechan²,

Davidson

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Trends in surgical management of urachal anomalies

Cited by 31 publications

References 29 publications

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

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

Giant umbilical cord in a normal preterm infant: a case report and review of the literature

Management of the giant umbilical cord: challenging the need for investigations in the newborn

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