Abstract
Urachal anomalies occur infrequently, but may be associated with morbidity, particularly when the diagnosis has been delayed. We retrospectively reviewed our institution’s experience over a 10-year and 7-month period in the investigation and management of suspected urachal anomalies. There were 25 children between November 1995 and June 2006, who presented with a suspected urachal anomaly. The mean age was 12 months (range 3 days to 13 years); 14 were male. Presentations included granulomatous polyp (16), umbilical discharge (4), umbilical sepsis (2) and abdominal pain (2). One case was diagnosed incidentally during a renal ultrasound scan (US). The main investigative tool was US (10), followed by micturating cystourethrogram (2). Of the 25 children, 12 had a patent urachus confirmed by subsequent further imaging or surgery. Our review suggests that whilst clinical examination remains important in the management of a child presenting with a possible urachal pathology, in 36% of the cases the correct diagnosis was only made with further radiological imaging or at operation. Surgical excision was effective with no morbidity or mortality.
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References
Kluth D, Hillen M, Lambrecht W (1995) The principles of normal and abnormal hindgut development. J Pediatr Surg 30:1143–1147
Parrott TS, Gray SW, Skandalakis JE (1994) The bladder and urethra. In: Skandalakis JE, Gray SW (eds) Embryology for surgeons. Williams and Wilkins, Baltimore, pp 671–717
Mesrobian HG, Zacharias A, Balcom AH et al (1997) Ten years of experience with isolated urachal anomalies in children. J Urol 158:5–8
McCollum MO, Macneily AE, Blair GK (2003) Surgical implications of urachal remnants: presentation and management. J Pediatr Surg 38:798–803
Herr HW, Bochner BH, Sharp D et al (1978) Urachal carcinoma: contemporary surgical outcomes. J Urol 178:74–78
Nakanishi K, Kawai T, Suzuki M et al (1996) Prognostic factors in urachal adenocarcinoma. A study in 41 specimens of DNA status, proliferating cell-nuclear antigen immunostaining, and argyrophilic nucleolar-organizer region counts. Hum Pathol 27:240–247
Daljeet S, Amreek S, Satish J et al (2004) Signet ring cell adenocarcinoma of the urachus. Int J Urol 11:785–788
Cilento BG Jr, Bauer SB, Retik AB et al (1998) Urachal anomalies: defining the best diagnostic modality. Urology 52:120–122
Holten I, Lomas F, Mouratidis B et al (1996) The ultrasonic diagnosis of urachal anomalies. Australas Radiol 40:2–5
Moore KL. (1988) The developing human. Saunders, Philadelphia
Skandalakis JE, Gray SW, Ricketts R, Skandalakis LJ (1994) The anterior body wall. In: Skandalakis JE, Gray SW (eds) Embryology for surgeons. Williams and Wilkins, Philadelphia, pp 540–593
Begg RC (1930) The urachus: its anatomy, histology and development. J Anat 64(Pt 2):170–183
Cappele O, Sibert L, Descargues J et al (2001) A study of the anatomic features of the duct of the urachus. Surg Radiol Anat 23:229–235
Suita S, Nagasaki A (1996) Urachal remnants. Sem Pediatr Surg 5:107–115
Newman BM, Karp MP, Jewett TC et al (1986) Advances in the management of infected urachal cysts. J Pediatr Surg 21:1051–1054
Iuchtman M, Rahav S, Zer M et al (1993) Management of urachal anomalies in children and adults. Urology 42:426–430
Nix JT, Menville MA, Wendt DL (1958) Congenital patent urachus. J Urol 79:264–273
Ueno T, Hashimoto H, Yokoyama H et al (2003) Urachal anomalies: ultrasonography and management. J Pediatr Surg 38:1203–1207
Ozbek SS, Pourbagher MA, Pourbagher A (2001) Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings. J Clin Ultrasound 29:218–222
Mshelbwala PM, Sabiu L, Chirdan LB et al (2006) Persistent umbilical discharge in infants and children. Ann Trop Paediatr 26:133–135
Ashley RA, Inman BA, Routh JC et al (2007) Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol 178:1615–1618
Khurana S, Borzi PA (2002) Laparoscopic management of complicated urachal disease in children. J Urol 168(4 Pt 1):1526–1528
Upadhyay V, Kukkady A (2003) Urachal remnants: an enigma. Eur J Pediatr Surg 13:372–376
Snyder CL (2007) Current management of umbilical abnormalities and related anomalies. Sem Pediatr Surg 16:41–49
Little DC, Shah SR, St Peter SD et al (2005) Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg 40:1874–1876
Turial S, Hueckstaedt T, Schier F et al (2007) Laparoscopic treatment of urachal remnants in children. J Urol 177:1864–1866
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Yapo, B.R., Gerges, B. & Holland, A.J.A. Investigation and management of suspected urachal anomalies in children. Pediatr Surg Int 24, 589–592 (2008). https://doi.org/10.1007/s00383-008-2136-6
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DOI: https://doi.org/10.1007/s00383-008-2136-6