An unusual bladder/cloacal exstrophy with urachal exstrophy.

The authors report a previously unpublished association of bladder exstrophy with cleft lip, exomphalos, Meckel's diverticulum imperforate anus, and a large urachal mass protruding below the umbilicus. The baby underwent surgical repair of the condition and the postoperative recovery was uneventful. None of the theories formulated to explain the embryogenesis of bladder exstrophy can explain these findings. The abnormality is within the bladder exstrophy/cloacal exstrophy spectrum.

Urachal remnant causing umbilical in-drawing during micturition.

The urachus is a vestigial remnant of the allantois, which is normally obliterated during fetal life to become the median umbilical ligament, which runs between the urinary bladder and umbilicus in adults. Failure of obliteration leaves a tubular urachal remnant, which may present with disease. We report a unique case of a urachal remnant causing umbilical pain and in-drawing on micturition in a nine-year-old boy. There was no urine discharge from the umbilicus and in-drawing did not occur on defecation. His urinary stream was normal. High frequency ultrasonography revealed a thick band with a narrow, anechoic, fluid filled central channel. Exploration via an infraumbilical curvilinear incision identified a thick urachal band that could be traced to the dome of the bladder. This was excised flush with the bladder. The patient remains well at nine months following surgery with complete cessation of symptoms.

Uroperitoneum in cattle: Ultrasonographic findings, diagnosis and treatment.

This review describes causes, clinical signs, metabolic changes in serum and peritoneal fluid, diagnosis and treatment of uroperitoneum. Rupture of the bladder or urachus is the most common cause of uroperitoneum. The main clinical sign is a pear-shaped enlargement of the abdomen accompanied by gradual deterioration in demeanour and appetite. Ultrasonography shows massive accumulation of anechoic abdominal fluid and organs suspended in the fluid. Bladder defects may be seen cystoscopically and the proximal part of a persistent urachus can be explored endoscopically. Abdominocentesis yields light yellow fluid. A peritoneal-to-serum creatinine concentration ratio of 2 or greater is diagnostic of uroperitoneum. Treatment consists of surgical repair of the defect.

[Cancer of the urachus. A rare form of tumors of the bladder]. / Le cancer de l'ouraque. Une forme rare des tumeurs de vessie.

Cancers of the middle umbilical fold are very infrequent, making up 0.1% to 0.7% of all bladder tumors. This type of tumor affects male subjects in 60% to 75% of cases, in the 5th or 6th decade of life. In more than 90% of all cases, the lesion is a mucosecretory adenocarcinoma developing from embryonic remains within the wall of the bladder and respecting the superficial urothelium of the bladder, which is affected only secondarily, contrary to what occurs in the other adenocarcinomas of the bladder. The pathogenesis remains controversial, especially the role of middle umbilical fold patency and of bladder carcinogens. The diagnosis is most often established late, because of a long clinical latency. It is mainly based on ultrasonography and computed tomography. Explorations of the bladder are useful only at an advanced stage. The prognosis is very poor, survival at 5 years ranging from 6.5% to 25% according to the authors. The treatment is mainly surgical. Only extensive exeresis with partial cystectomy extending to the peri- and supravesical environment, including the peritoneum and the umbilicus, and associated with pelvic lymphadenectomy may give some hope. Chemotherapy and radiation therapy, either alone or complementary, are disappointing. The prognosis may be improved only by an early diagnosis.

Anomalía del uraco sobreinfectada como causa de irritabilidad en un lactante / Infected urachal abnormality as the cause of an infant irritability

Presentamos el caso de una lactante de cinco meses que presenta irritabilidad y distensión abdominal en la presentación de una anomalía congénita del uraco. El texto repasa la sintomatología, las pruebas complementarias y el tratamiento, así como los principales diagnósticos diferenciales (AU)

We report the case of a 5-month old infant who presents irritability and abdominal distention in the context of a congenital anomaly of the urachus. Symptomatology, additional tests and treatment, as well as the main differential diagnoses, are reviewed in the text (AU)

Cistectomía parcial laparoscópica asistida por robot da Vinci para el tratamiento del adenocarcinoma de uraco / Urachal adenocarcinoma treated with robotic assisted laparoscopy partial cystectomy

OBJETIVO: Describir un caso de adenocarcinoma de uraco tratado con cistectomía parcial con extracción en bloque del uraco y ombligo por vía laparoscópica asistida por robot y hacer una revisión de la literatura. MÉTODOS: Varón de 63 años que consultó por hematuria y dolor durante la micción en hipogastrio diagnosticado de adenocarcinoma localizado de uraco mediante resección transuretral de vejiga y tomografía axial computada (TAC). Se realizó una cistectomía parcial laparoscópica asistida por robot utilizando una unidad da Vinci® (Intuitive Surgical System) modelo S HD de cuatro brazos. Describimos la técnica quirúrgica y evaluamos el tiempo de consola, tiempo quirúrgico total, sangrado introperatorio, anatomía patológica, márgenes quirúrgicos, evolución postoperatoria y su situación clínica tras 5 meses de seguimiento. RESULTADOS: Se dispusieron 4 trocares robóticos y uno adicional para la aspiración. Se demarco el limite vesical por vía endoscópica para asegurar márgenes negativos.. El tiempo de consola fue de 1:54hs, tiempo total de cirugía de 2:48hs con un sangrado de 100ml. Evolucionó sin complicaciones con alta a las 48hs. La sonda vesical fue retirada a los 15 días permaneciendo con una capacidad vesical de 300ml al mes de la cirugía. La anatomía patológica informó un adenocarcinoma de uraco pobremente diferenciado con infiltración del tejido fibroadiposo perivesical y márgenes quirúrgicos libres de tumor. Clasificación de Sheldon IIIB y Ontario III. Sin signos de recidiva a los 7 meses de seguimiento. CONCLUSIÓN: La cistectomía parcial con extracción en bloque del uraco y ombligo realizada por vía laparoscópica asistida por robot es factible (AU)

OBJECTIVE: To describe a case of urachal adenocarcinoma treated with robotic assisted laparoscopic partial cystectomy and en-bloc exeresis of urachus and umbilicus and bibliographic review. METHODS: A 63 year-old man with hematuria and hypogastric pain. He was diagnosed of urachal adenocarcinoma by transurethral resection and axial tomography. We performed a robotic assisted laparoscopic partial cystectomy using a da Vinci® S HD (Intuitive Surgical System) device. We describe the surgical technique and examine total length of time for surgery and for console, pathology report, margin status, postoperative outcome and oncological status 7 months after surgery. RESULTS: 4 ports were used for robotic arms and one additional for the assistant. Cystoscopy was performed during surgery to mark tumor margins. Bladder was closedusing a running suture with Poliglactin 0. Total length time for surgery was 2hs 28 minutes, console time was 1h54`. Two days later patient was discharged and no complication was reported. After two weeks Foley cathether was removed and bladder volume was 300ml. Pathology report informed undifferentiated urachal adenocarcinoma with perivesical tissue infiltration with margins free from tumor, corresponding to Sheldon IIIB and Ontario III classification. Seven months later patient was fee from recurrence. CONCLUSION: Robotic assisted laparoscopy partial cystectomy with en-bloc exeresis of urachal and umbilicus is feasible (AU)

Uraco persistente en el adulto / Persisting urachus in the adult

Se presentan 2 casos de uraco persistente en el adulto. Un quiste y un uraco abierto a ombligo. Se discute la etiopatogenia. Ambos fueron resecados con éxito