Are urachal remnants really rare in children? An observational study.

Urachal remnants are thought to have a low prevalence. However, recent studies indicate a higher rate. The aim of this study was to evaluate the prevalence of urachal remnants in children referred for imaging by abdominal/urinary/suprapubic ultrasonography in one calendar year. Files of children who underwent abdominal/urinary/suprapubic ultrasonography in one calendar year were retrospectively reviewed. Data regarding children ≤17 years that underwent ultrasonography of the ventral abdominal wall while being assessed for various reasons were collected. Anomalies detected, age, gender, reason for ultrasonography request, and diagnosis of the urachal remnant were noted. All ultrasonography assessments were performed by a single pediatric radiologist in a single institution. There were 4836 patients in the study (1919 boys). Median age of the whole cohort was 7 years. A total of 10 patients were found to have urachal remnants, which included eight urachal cysts (three boys) and two urachal diverticula (one boy).Conclusion: The prevalence of urachal remnants in our cohort was nearly 2 in every 1000 children. More specifically, the prevalence of urachal cysts was one in 600. What is Known: • Urachal remnants were believed to be rare. • Recent studies indicated a higher incidence than previous reports. What is New: • This study shows that urachal remnant may be observed in one every 500 children that undergo ultrasonography of the abdomen for various reasons. • Parental counselling and management of urachal remnants should be planned accordingly.

Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults.

The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ±â€Š15.4 vs 69.2 ±â€Š13.9 minutes, P = .189) and intraoperative blood loss (29.4 ±â€Š13.3 vs 32.2 ±â€Š12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ±â€Š1.8 vs 6.1 ±â€Š1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ±â€Š0.5 vs 3.6 ±â€Š0.8 days, P < .001) and the time of full recovery (11.2 ±â€Š1.9 vs 15.6 ±â€Š3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ±â€Š8.1 and 34.1 ±â€Š8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.

Umbilical cord cysts in the first trimester: are they associated with pregnancy complications?

OBJECTIVES: To determine whether umbilical cord cysts found by transvaginal sonography in the first trimester of pregnancy are associated with poor pregnancy outcomes. METHODS: We conducted a matched cohort study between July 2006 and July 2008. Patients with umbilical cord cysts found on transvaginal sonography in the first trimester were matched to patients with normal umbilical cords. After the completion of these pregnancies, medical histories and pregnancy outcomes were reviewed from the hospital's electronic record. Sonograms were reviewed to obtain descriptive information about the umbilical cord cysts. Outcomes between the cohorts were compared. RESULTS: Forty-five patients with umbilical cord cysts were identified and compared to 85 patients with normal umbilical cords. The mean gestational age of the cysts ± SD at diagnosis was 8 weeks 3 days ± 3.5 days. The mean cyst diameter was 3 ± 2.1 mm. All cysts resolved on follow-up sonography, which was performed between 9 weeks 4 days and 20 weeks 5 days. Patients with umbilical cord cysts were found to have a lower body mass index than those with normal umbilical cords. There was no significant difference in abnormal sonographic findings between cohorts. Five sonographic fetal abnormalities were found in the umbilical cord cyst cohort (11.1%) and 8 in the normal umbilical cord cohort (9.4%). There were 2 intrauterine fetal demises in the umbilical cord cyst cohort and 1 in the normal umbilical cord cohort. There was no difference between the cohorts when comparing gestational age at delivery and birth weight. CONCLUSIONS: There does not appear to be an association between poor pregnancy outcomes and umbilical cord cysts during the first trimester.

Laparoscopic management of complicated urachal remnants in adults.

OBJECTIVES: The traditional surgical approach for removing a urachal remnant is via a large transverse or midline infraumbilical incision. We review our experience with laparoscopic urachal cyst excision and report the efficacy and outcomes of this approach as a less morbid, minimally invasive alternative. METHODS: Between August 2005 and March 2009, eight patients with a mean age of 26 years who had symptomatic urachal cysts underwent laparoscopic radical excision of the urachal remnant. Using three ports, the urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact via the umbilicus. Umbilicoplasty was performed by a plastic surgeon. We retrospectively reviewed the perioperative records to assess morbidity and outcomes. RESULTS: All eight operations were completed successfully. No intraoperative or postoperative complications were reported at a mean follow-up of 3.2 years. Mean operative time was 147.5 min including umbilicoplasty. Pathological evaluation confirmed a benign urachal remnant in each case. There have been no recurrences of symptoms nor postoperative complications during follow-up. Mean time to full recovery, defined as return to normal life without pain, was 16 days. The patients with bladder cuff resection had a delayed full convalescence (25 vs. 13 days) due to a minimum degree of dysuria. CONCLUSION: A laparoscopic approach with the removal of urachal remnants via the umbilicus appears to be a safe and effective alternative with better cosmesis when compared to an open approach.

Relevance of infection in children with urachal cysts.

OBJECTIVE: To assess the role of infection in the management of children with urachal cysts. METHODS: A retrospective study on 10 children with urachal cysts operated on over an 11-year period (from 1987 to 1998) was performed. Uncomplicated urachal cysts were found in 2 children who underwent primary cyst removal. The remaining 8 were admitted with severe sepsis due to the presence of a urachal abscess; they were managed by a staged approach including percutaneous drainage and delayed cyst removal. The diagnosis of urachal cyst was readily made by ultrasound in all the 10 patients (100%). In 1 patient with urachal abscess, computed tomography provided additional information. RESULTS: The postoperative course was uneventful in 9 of 10 children (90%). A 5-year-old female patient developed peritonitis following urachal abscess rupture into the peritoneal cavity, which resulted in additional surgery and prolonged hospitalization. CONCLUSIONS: (1) Ultrasound is an excellent diagnostic tool for patients with urachal cysts. (2) A renal screening ultrasound must be included in the preoperative work-up. (3) A thorough urological assessment is indicated in patients with abnormal renal ultrasound of recurrent urinary infections. (4) At present, a staged surgical procedure still remains the most effective surgical option in children with urachal cyst.

Umbilical cord cysts in early pregnancy.

OBJECTIVE: To assess the prevalence, morphologic characteristics, and natural history of umbilical cord cysts detected by ultrasound in the first trimester of pregnancy. METHODS: This was an ultrasound screening study for the presence of umbilical cord cysts in 859 pregnant women with singleton live fetuses at 7-13 weeks' gestation. In all cases of cord cysts the scan was repeated fortnightly until the cyst resolved or a fetal abnormality was detected. All patients with ongoing pregnancies had detailed scans at 20 weeks. Infants and umbilical cords were examined after delivery for the presence of structural abnormalities. RESULTS: Umbilical cord cysts were present in 29 (3.4%) of the 859 pregnancies. Fetal abnormalities were found in seven (26%) of the 27 cases with ongoing pregnancies. The fetus was more likely to be abnormal if the cyst was located near the placental or fetal extremity of the cord (relative risk [RR] 3.3; 95% confidence interval [CI] 1.3, 8.5) or paraxially (RR 3.8; 95% CI 1.2, 12.0) or if it persisted beyond 12 weeks' gestation (RR 7.7; 95% CI 3.2, 18.6). CONCLUSIONS: The prevalence of umbilical cord cysts at 7-13 weeks' gestation is approximately 3%, and in more than 20% of cases there are fetal chromosomal or structural defects.

Urachal abscesses: protean manifestations, their recognition, and management.

We present the manifestations, their recognition, and treatment of urachal disorders, as well as report on 3 cases of urachal abscess in children. A review of the English literature is included.

Benign non-infected urachal cyst in an adult: review of the literature and a case report.

Urachal cyst is rather a rare lesion with interesting and different ways of presentation. More urachal cysts are being shown by ultrasound and computed tomography, and their criteria for diagnosis are discussed.