Urachal anomalies in children: surgical or conservative treatment?

OBJECTIVE: To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children. PATIENTS AND METHODS: A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records. RESULTS: Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months. CONCLUSION: With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful.

Tuberculosis of the urachal cyst.

Urachal cysts are uncommon. Rarely, these cysts can become infected. Tuberculosis of the urachal cyst is exceedingly rare, with only one case reported previously in the English language literature. Here we report the case of a 23-year-old male who presented with an infra-umbilical mass that turned out to be tuberculosis of the urachal cyst.

Clinical presentations of schistosoma hematobium: three case reports and review.

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

Nonoperative management of symptomatic urachal anomalies.

INTRODUCTION: Symptomatic urachal anomalies are rare disorders that consist of urachal remnants or fistulas with or without an associated cyst. Traditionally, when a urachal anomaly was recognized, operative excision was performed. There has been a shift toward the nonoperative management of urachal anomalies at many centers, although there is little in the literature to support this practice. METHODS: A retrospective chart review of patients with urachal anomalies was performed from January 2002 to March 2008. Children with a draining umbilicus and no radiographic or surgical confirmation of a urachal anomaly were excluded. RESULTS: Fifteen patients with symptomatic urachal anomalies were identified. The average age was 3.5 years (4 weeks to 14 years). Symptoms included umbilical drainage (n = 10), abdominal pain (n = 6), omphalitis (n = 4), intraabdominal mass (n = 3), dysuria (n = 1), recurrent urinary tract infections (n = 1), and fever (n = 4). The diagnosis was confirmed by ultrasound (n = 13) and/or computed tomographic scan (n = 4). The surgically treated cases included 7 urachal cysts (5 uninfected, 2 infected) and 1 patent urachal fistula. Mean follow-up is 37 months, and there have been no reported recurrences. Those treated without surgical excision included 4 patent urachal fistulas (mean follow-up, 20 months-no recurrences) and 3 infected urachal cysts (percutaneous drainage [n = 2] and laparoscopic drainage [n = 1]-no recurrences on ultrasound at 26 months). CONCLUSION: Nonoperative management of urachal anomalies is a reasonable approach and may be extended to infected urachal cysts after initial drainage. Infected cysts that are adequately drained seem to obliterate with time. Modern ultrasonography facilitates thorough follow-up. We propose a treatment algorithm for the management of suspected urachal anomalies.

Median raphe cyst. Report of two cases and literature review.

OBJECTIVES: To report 2 cases of median raphe cysts, 1 in the penis and the other in the perineum. METHOD: Two cases of median raphe cyst are described; the first was treated by surgery and the second required no treatment. RESULTS: The surgical patient experienced no complications and was asymptomatic with no recurrence at 2 years. CONCLUSIONS: Median raphe cysts are a rare, benign condition of uncertain etiology. Treatment consists on simple excision.

[Infected urachal cyst during childhood]. / Quiste de uraco infectado en edad infantil.

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.

Hematuria associated with cystic hematomas in three neonatal foals.

Cystic hematomas were diagnosed in 3 neonatal foals. In all 3 foals, cystic hematomas resulted from umbilical trauma or thrombocytopenia. Findings in these foals suggest that cystic hematoma should be included in the differential diagnosis of hematuria in neonatal foals. Management of cystic hematomas includes both medical and surgical options.

Patología umbilical / Umbilical pathology

La patología umbilical es muy frecuente durantela edad pediátrica. En este artículo se revisa toda lapatología que puede aparecer a nivel umbilical, preferentementede origen congénito o adquirido. Serevisa el onfalocele, la patología por conducto onfalomesenterico,la persistencia de uraco, así comolas hernias umbilicales, supraumbilicales y las herniasepigástricas, haciendo especial hincapié en losaspectos diagnósticos y terapéuticos

The umbilical pathology is frequent during childhood.This paper reviews the pathology that couldappear to umbilical level of congenital or acquiredorigin. Diagnostic and therapeutic aspects of omphalocele,omphalomesenteric duct and sinus, urachus,umbilical hernias, midline and epigastric herniasare revised

Úraco persistente: relato de caso / Persistent urachus: case report

O úraco é uma estrutura fetal que conecta a bexiga à cicatriz umbilical, persistindo em raras ocasiões. Os poretadores esta entidade podem, ocasionalmente, apresentar sintomas. A persistência do úraco pode ser classificada em congênita ou adquirida. Nesta fecha normalmente, podendo recanalizar após o nascimento, e constitui um dos cinco tipos de anormalidades do úraco: úradco persistente, seio umbilical de úraco, divertículo vésico-uracal, cisto de úraco e seios alternantes de úraco. Os sintomas podem variar com o tipo de alteração encontrada ou a presença de infecção concomitante. Métodos de imagem podem ser úteis e o tratamento depende do tipo ed doença que envolve o úraco persistente. Com o objetivo de relatar a ocorrência de úraco persistente em uma paciente adulta, ressaltando a importância diagnóstica, descreve-se o caso de uma mulher de 28 anos com abaulamento na região umbilical, de consistência fibro-elástica, indolor à palpação. O exame ultrassonográfico detectou cisto subumbilical. Foi submetida a tratamento cirúrgico com evidência de cisto vesical. A paciente evoluiu sem intercorrências no pós-operatório. O exame histopatológico foi compatível com um cordão fibro-muscular com camada interna de epitélio transicional, camada média de tecido conectivo e camada externa muscular, sendo o cisto epidérmico

[Clinical study of six cases of pyourachus at our hospital].

We encountered 6 patients with pyourachus (male, 1; female, 5) who ranged in age from 17 to 58 years (mean, 41 years) during the 7 years from 1993 to 1999. Three of them had a history of gynecological surgery, and 2 had a history of appendectomy. Improvement was observed in one patient with conservative therapy alone, but the other 5 patients underwent surgery. Preoperatively, 2 patients underwent drainage, one of them through the umbilicus, and the other through a position on the midline percutaneously. Pathological examination in the 5 patients revealed no evidence of cancer. With reference to postoperative complications, adhesive ileus was recognized in 1 case one year postoperatively but no other complications were noted in the other 5 cases. No evidence of recurrence has been seen in any of these patients to date.

[A case of infected urachal cyst successfully drained by a catheter perforating the bladder].

A 42-year-old man complained of lower abdominal pain. Computed tomographic scan and magnetic resonance imaging revealed an infected urachal cyst. A drainage catheter, which had multiple holes over a 10 cm length from the catheter tip, was placed in the urachal cyst. The catheter was inserted from the subumbilicus region and the catheter tip was intended to be situated at the caudal end of the urachal cyst. However, the catheter tip accidentally perforated the bladder and urine flowed out of the bladder through the catheter. Because the urine diluted and washed out the pus in the urachal cyst, the infected urachal cyst was successfully drained. Percutaneous drainage and antibiotics allowed resolution of the inflammatory process. On the twenty-third day after catheter placement, excision of the urachal cyst and partial cystectomy were performed with relative ease and without any complications.