Urachal remnant with heterotopic sinus in an adult male

Abstract

Introduction: Urachal remnant with heterotopic sinus is an extremely rare congenital anomaly, and usually coexists with other congenital anomalies. We report the case of a 32-year-old adult male with urachal remnant with heterotopic sinus. Patient concerns: A 32-year-old adult male presented with purulent secretion in the heterotopic sinus on the dorsal side of the normal external urethral orifice and pain in the balanus since 5 months. Diagnosis: The computed tomography scan demonstrated a 4 cm cystic mass next to the anterior wall of the urinary bladder. Retrograde urethrography was performed, which demonstrated that this mass communicated with the heterotopic sinus on the dorsal side of the normal external urethral orifice. Cystoscopy showed that there was no communication between the mass and the bladder. Pathology results confirmed that this mass was urachal tissue. Interventions: The patient underwent a laparoscopy surgery to undertake the cystic mass, part of the anterior wall of urinary bladder and the epithelium of channel which communicated with the cystic mass. Outcomes: The patient was discharged without any complications after 6 months and follow-up was continued in the clinic. Conclusions: Urachal remnant with heterotopic sinus is rare, and we recommend that urachal remnant should be considered when a patient presents with a mass in the retropubic space.

Urachal sinus: An atypical case and review of the literature

“… 2 The urachal length varies from 3 to 10 cm, and diameter ranges from 8 to 10 mm. 2 , 3 The urachus involutes normally before birth and persists as a fibrous band. 2 The Fox's classification defines 4 types of anomalies according to urachal obliteration defects: 1) Patent urachus (50%); 2) Urachal cyst (30%); 3) Urachal sinus (15%); 4) Vesicourachal diverticulum (3%).…”

“… 2 The Fox's classification defines 4 types of anomalies according to urachal obliteration defects: 1) Patent urachus (50%); 2) Urachal cyst (30%); 3) Urachal sinus (15%); 4) Vesicourachal diverticulum (3%). 2 , 3 Patent urachus is a congenital disease and the rest are acquired.…”

“…If urachal sinus is overinfected, surgery should be performed after infection is controlled. 3 The excision of the urachal remnant is curative, avoiding complications such as fistulas, sepsis, recurrences, and possible malignancy. 4 Currently, the main approach has become laparoscopic o robotic excision, with all the advantages of minimal invasive surgery: minimum morbidity, shorter hospital stay and faster overall recovery.…”