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Pediatrics International : Official... 2023
Topics: Pregnancy; Female; Humans; Urachus; Prenatal Diagnosis; Urachal Cyst; Umbilical Cord; Ultrasonography, Prenatal
PubMed: 37804061
DOI: 10.1111/ped.15633 -
Journal of Pediatric Urology Feb 2024Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may...
INTRODUCTION
Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge.
OBJECTIVE
To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery.
STUDY DESIGN
All patients diagnosed with a UA from 2016 to 2020 at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies.
RESULTS
Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p < .0001). Though, urology was more likely to treat patients who presented incidentally (p < .01), and general surgery was more likely to treat patients who presented with an infected remnant (p < .01). Patients of male sex were more likely overall to receive surgery compared to female patients (p < .01).
DISCUSSION
Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients.
CONCLUSIONS
Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.
Topics: Child; Humans; Male; Female; Retrospective Studies; Urology; Urachus; Conservative Treatment; Urologists; Urachal Cyst
PubMed: 37802719
DOI: 10.1016/j.jpurol.2023.09.013 -
Journal of Medical Case Reports Aug 2023Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a...
BACKGROUND
Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties.
CASE PRESENTATION
A 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms.
CONCLUSIONS
Intravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.
Topics: Male; Child; Humans; Child, Preschool; Urachal Cyst; Urinary Bladder Neoplasms; Urinary Bladder; Cysts; Pelvis
PubMed: 37612773
DOI: 10.1186/s13256-023-04110-w -
Cureus Jul 2023Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of...
Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of incomplete obliteration, the urachus can undergo a variety of urachal anomalies. An umbilical fistulogram and a voiding cystourethrogram both supported the existence of the adult urachal cyst in this case. To treat the sepsis, we provided the patient with antibiotics first, then a surgical procedure. The entire vesico-umbilical tract with the urachal cyst was removed using the open approach. The excised specimen's histology revealed a foreign body giant cell reaction without any indication of malignancy. The presentation and diagnosis of vesico-umbilical urinary fistula (VUUF) in adults can occasionally be difficult. They happen very rarely. So we began putting forward this case for the same reason.
PubMed: 37551248
DOI: 10.7759/cureus.41503 -
Cureus Jun 2023Urachal cysts (UCs) are rare congenital anomalies, especially in adults. They often mimic a variety of intra-abdominal pathologies, making the diagnosis difficult....
Urachal cysts (UCs) are rare congenital anomalies, especially in adults. They often mimic a variety of intra-abdominal pathologies, making the diagnosis difficult. Laparotomy and excision of the cyst along with the umbilicus has been the traditional technique. A 33-year-old female presented with painful umbilical swelling. A CT scan was suggestive of a UC. We performed an umbilicus-preserving laparoscopic excision of the cyst. We describe this rare case and review literature related to the surgical treatment of UCs.
PubMed: 37489200
DOI: 10.7759/cureus.40846 -
Surgical Case Reports Jul 2023A few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have...
BACKGROUND
A few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have indicated the existence of urachal anomalies and umbilical cysts related to bladder evagination. The incidence of urachal anomalies at birth is reported to be 1 in 5000-8000 live birth, and urachal aplasia is rare. Herein, we report a rare, novel case of urachal aplasia.
CASE PRESENTATION
We encountered a small omphalocele with bladder evagination associated with urachal aplasia for which the neonate underwent surgery one day after birth. The patient was a one-day-old boy with a prenatally diagnosed omphalocele. A fetal magnetic resonance image (MRI) scan (25 weeks of gestation) revealed a 30 × 33 mm (approximately 1.3 in.) cystic lesion which was suspected to be an umbilical cyst. The baby was born vaginally at 38 weeks, weighing 2956 g. An omphalocele (hernial orifice diameter, 4 cm × 3 cm) with bladder prolapse was recognized. After sac excision, the prolapsed bladder was resected and closed with two-layer sutures. In order to secure sufficient bladder capacity, we estimated the minimum residual volume as 21 ml after bladder plasty. The remaining bladder capacity was confirmed to be 30 ml by injecting a contrast dye and saline into the bladder. The neonate had no associated cardiac urogenital or skeletal anomalies. Postoperative course was uneventful. The patient was regularly followed up for two years after surgery and underwent umbilicoplasty. He had no trouble with urinary function.
CONCLUSION
In this case, we experienced extremely rare condition of a small omphalocele with bladder evagination associated with urachal aplasia and reviewed 7 case reports of anomalies similar to those in the present case. Umbilical cord cysts may be an informative indicator of these symptoms in utero. Therefore, ultrasonography scans should be conducted until delivery, despite the spontaneous disappearance of cord cysts.
PubMed: 37428342
DOI: 10.1186/s40792-023-01710-y -
Journal of Pediatric Surgery Sep 2023
Topics: Humans; Child; Urachus; Urinary Tract; Urachal Cyst
PubMed: 37246044
DOI: 10.1016/j.jpedsurg.2023.04.022 -
Journal of Medical Case Reports May 2023Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus....
BACKGROUND
Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition.
CASE PRESENTATION
Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts.
DISCUSSION
Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach.
CONCLUSION
Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.
Topics: Male; Female; Humans; Adult; Urachal Cyst; Cysts; Laparoscopy; Paranasal Sinuses
PubMed: 37221572
DOI: 10.1186/s13256-023-03944-8 -
Journal of Minimal Access Surgery 2023To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults.
AIM
To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults.
PATIENTS AND METHODS
A retrospective study included all patients who underwent laparoscopic excision of URs during the period January 2015-January 2020. The following data were retrieved from the files of the patients: demographic data, clinical presentations, intra-operative findings, the procedure performed, operative details, intraoperative or post-operative complications and follow-up period mentioned in the files for those patients.
RESULTS
The study included 10 patients (four males and six females) with a mean age of 27.8 ± 11.0 years. URs were discovered preoperatively in all patients except one patient who was diagnosed intraoperatively. URs were associated with other pathologies in four patients (40%) that required two simultaneous surgical procedures. Eight patients (80%) presented with simple umbilical discharge and were diagnosed easily by ultrasonography. All patients were managed successfully with laparoscopic excision and umbilical sparing technique. Excision of the dome of the bladder was done on the selective approach to one patient. No patients showed early post-operative complications. Only one patient had stitch sinus 6 months postoperatively due to a concomitant hernia repair rather than due to the excision of the URs.
CONCLUSIONS
Laparoscopic excision of symptomatic urachus is a feasible procedure even when the excision of the bladder is required. It could be performed successfully with other pathologies. It is associated with a low incidence of complications. Laparoscopy allows good visualisation and complete excision that leads to almost no recurrence rate.
PubMed: 37056087
DOI: 10.4103/jmas.jmas_72_22 -
BMC Pediatrics Mar 2023A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth.
BACKGROUND
A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth.
CASE PRESENTATION
We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder.
CONCLUSION
Complicated urachal cysts can present with acute abdominal pain.
Topics: Female; Humans; Child; Child, Preschool; Urachal Cyst; Abdominal Pain; Abdomen, Acute; Laparoscopy; Emergency Service, Hospital
PubMed: 37004016
DOI: 10.1186/s12887-023-03962-x