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Journal de Gynecologie, Obstetrique Et... May 2014Prenatal ultrasonographic features of patent urachus consist in anechoic proximal cord cyst communicating with the bladder associated with large umbilicus. Distinction...
Prenatal ultrasonographic features of patent urachus consist in anechoic proximal cord cyst communicating with the bladder associated with large umbilicus. Distinction should be made with omphalocele and bladder extrophy. Spontaneous evolution leads to rupture during mid-trimester and bladder protrusion. Karyotyping is not mandatory in isolated typical cases. Early postnatal surgery is usually required.
Topics: Adult; Disease Progression; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal; Urachus; Urinary Bladder; Urogenital Abnormalities
PubMed: 23523249
DOI: 10.1016/j.jgyn.2013.02.005 -
The Israel Medical Association Journal... Nov 2016The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. (Comparative Study)
Comparative Study
BACKGROUND
The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision.
OBJECTIVES
To report our experience with laparoscopic/open urachus excision as a minimally invasive diagnostic and surgical technique.
METHODS
This was a retrospective study involving patients who were diagnosed with persistent urachus and underwent laparoscopic/open excision. The morbidity, recovery, and outcomes of surgery were reviewed.
RESULTS
Eight patients (males:females 6:2) with an age range of 1 month to 17 years underwent laparoscopic or open excision (six and two patients respectively). All patients presented with discharge from the umbilicus. Although three patients had no sonographic evidence of a patent urachus, diagnostic laparoscopy detected a patent urachus that was excised laparoscopically. The operative time of laparoscopic surgery ranged from 19 to 71 minutes (the last case was combined with bilateral laparoscopic inguinal hernia repair), and the mean duration of hospital stay was 2.0 ± 0.36 days. Pathological examination confirmed a benign urachal remnant in all cases.
CONCLUSIONS
Laparoscopy is a useful alternative for the management of persistent or infected urachus, especially when its presence is clinically suspected despite the lack of sonographic evidence. The procedure is associated with low morbidity, although a small risk of bladder injury exists, particularly in cases of severe active inflammation.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Laparoscopy; Length of Stay; Male; Operative Time; Retrospective Studies; Treatment Outcome; Urachus; Urologic Surgical Procedures
PubMed: 28466617
DOI: No ID Found -
Urology Annals 2015Posterior urethral valve (PUV) is a common cause of lower urinary tract obstruction in male infants with an incidence of 1:5000-8000. PUV continues to be a significant...
Posterior urethral valve (PUV) is a common cause of lower urinary tract obstruction in male infants with an incidence of 1:5000-8000. PUV continues to be a significant cause of morbidity and ongoing renal damage in infants and children. It can coexist with vesicoureteral reflux (VUR) in about 50% of cases and also with patent urachus in about one-third of cases. It is a case of a 22-day-old full-term male child who presented with poor urinary stream and progressive abdominal distension of 5-day duration as well as leakage of clear fluid from umbilicus of 1-day duration. Abdominopelvic ultrasonography showed bilateral hydronephrosis. Micturating cystourethrogram also showed features of bladder outlet obstruction and PUV. In addition, a grade V left VUR and a fistulous tract between the dome of the urinary bladder and the umbilicus, which was consistent with a patent urachus was demonstrated. In conclusion, this case demonstrates a rare combination of congenital urinary tract anomalies involving PUV, left VUR and patent urachus.
PubMed: 25836363
DOI: 10.4103/0974-7796.150496 -
Asian Journal of Surgery Apr 2015The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this...
BACKGROUND
The traditional surgical approach to the excision of persistent urachal remnants is a lower midline laparotomy or semicircular infraumbilical incision. The aim of this study is to report our experience with laparoscopic urachus excision as a minimally invasive diagnostic and surgical technique.
METHODS
This study was a prospective study involving patients who were diagnosed with persistent urachus and underwent laparoscopic excision. The morbidity, recovery, and outcomes of surgery were reviewed.
RESULTS
Fourteen patients (8 men) with a mean age of 22.8 ± 6.42 years underwent laparoscopic excision. All patients presented with discharge from the umbilicus. Although four patients had no sonographic evidence of a patent urachus, a diagnostic laparoscopy detected a patent urachus that was excised laparoscopically. One patient required laparoscopic reoperation for persistent discharge, and one patient presented with bladder injury, which was repaired via a small Pfannenstiel incision without any morbidity. The mean operative time was 71.1 ± 0.28 minutes, and the mean duration of hospital stay was 1.3 ± 1.38 days. Pathological examination confirmed a benign urachal remnant in all cases.
CONCLUSION
Laparoscopy is a useful alternative for the management of persistent or infected urachus, especially when its presence is clinically suspected despite the lack of sonographic evidence. The procedure is associated with low morbidity, although a small risk of bladder injury exists, particularly in cases of severe active inflammation. Recurrence is uncommon and was caused by inadequate excision of inflammatory tissue in our series that was easily managed laparoscopically.
Topics: Adult; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Retrospective Studies; Treatment Outcome; Urachus; Young Adult
PubMed: 24947766
DOI: 10.1016/j.asjsur.2014.04.009 -
F1000Research 2015Patent urachus is a rare congenital abnormality. Since its first description by Cabriolus in 1550, few cases have been reported. A 26-year-old Vietnamese primigravida...
Patent urachus is a rare congenital abnormality. Since its first description by Cabriolus in 1550, few cases have been reported. A 26-year-old Vietnamese primigravida presented at 20 weeks of gestation for evaluation of a cystic mass in the umbilical cord, which was first discovered at week 13 of pregnancy by ultrasound scan. The cystic mass originated from the root of the umbilical cord, connected to the urinary bladder, and no intestinal contents were enclosed within. Doppler ultrasound assessment showed that the single umbilical artery existed within the normal range. The progression of the umbilical cyst continued to be screened, but the mass disappeared on ultrasound images at 27 weeks of gestation. This led to the consideration of the cyst's rupture. After 38 gestational weeks, the pregnant woman delivered a 3350g male infant via cesarean section because of an obstructed vaginal labor. The following days, a stream of urine was recorded leaking out from the umbilical mass whenever he cried. Seven weeks after delivery, an open surgical approach was successfully performed. The baby is now 43 months of age, growing and developing normally. Since an allantoic cyst with patent urachus is a rare clinical entity, early discovery, close monitoring and accurate diagnosis through ultrasound in the prenatal period may consequently allow clinicians to have suitable attitudes towards management when the infant is born.
PubMed: 26213613
DOI: 10.12688/f1000research.6546.1 -
Medicine Jul 2017Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the...
RATIONAL
Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision.
PATIENT CONCERN
A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health.
DIAGNOSIS
After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected.
INTERVENTIONS
The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed.
OUTCOME
The postoperative course was favorable and uneventful.
LESSONS
Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach.
Topics: Humans; Infant, Newborn; Laparoscopy; Male; Minimally Invasive Surgical Procedures; Ultrasonography; Umbilicus; Urachus
PubMed: 28746173
DOI: 10.1097/MD.0000000000007087 -
Medicine May 2022A patent urachus is a rare congenital anomaly that atypically presents as an umbilical cord cyst or large umbilical cord. Here we describe a case of a giant umbilical...
RATIONALE
A patent urachus is a rare congenital anomaly that atypically presents as an umbilical cord cyst or large umbilical cord. Here we describe a case of a giant umbilical cord cyst in a newborn diagnosed as a patent urachus.
PATIENT CONCERNS
A male infant with a birth weight of 3260 g was transferred because of an antenatally diagnosed giant umbilical cord cyst accompanied by yellowish discharge and granulation in the umbilical cord after birth.
DIAGNOSES
Patent urachus.
INTERVENSIONS
The patent urachus was treated by excision of the urachal remnant followed by partial cystectomy.
OUTCOMES
Postoperative orchitis with pyocele occurred and was treated with a course of antimicrobial therapy; and no other complications developed.
LESSONS
Newborns with a giant umbilical cord or umbilical cord cysts should be examined for possible accompanying urachal anomalies, even if antenatal ultrasound shows no other suspicious findings, to prevent delayed diagnosis and subsequent complications.
Topics: Communicable Diseases; Cysts; Female; Humans; Infant; Infant, Newborn; Male; Musculoskeletal Diseases; Pregnancy; Ultrasonography, Prenatal; Umbilical Cord; Urachus; Urinary Bladder
PubMed: 35608419
DOI: 10.1097/MD.0000000000029187 -
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 -
Ginekologia Polska 2021An urachus is a remnant of allantois in embryo development constituting a connection between the dome of the bladder and umbilicus. It develops on day 16 after...
An urachus is a remnant of allantois in embryo development constituting a connection between the dome of the bladder and umbilicus. It develops on day 16 after conception and closes during the pregnancy to form the median umbilical ligament. Patent urachus results from a failure in closing its lumen in 10-12 gestational weeks. This anomaly occurs in 1-2 babies in 100,000 births. We present the case of patent urachus. In 20 gestational weeks, a dilatation of the umbilical cord with an anechoic mass with a transverse dimension of 19 x 12 mm starting from the fetal insertion and length of 30 cm was seen on ultrasound without any other fetal and placental disorders. Histology showed cystic edema. Prenatal diagnosis of patent urachus can be difficult because this pathology may be mistaken with other, more dangerous causes of cord cysts; thus, the occurrence of cord cysts should be closely monitored.
Topics: Dilatation; Female; Humans; Placenta; Pregnancy; Ultrasonography, Prenatal; Umbilical Cord; Urachus
PubMed: 34541633
DOI: 10.5603/GP.a2021.0156 -
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