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Sukiman B, Santiana L. An infected urachal cyst forming an abscess: A case report. Radiol Case Rep 2024; 19:5926-5931. [PMID: 39328943 PMCID: PMC11424908 DOI: 10.1016/j.radcr.2024.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/18/2024] [Accepted: 08/19/2024] [Indexed: 09/28/2024] Open
Abstract
Urachal cysts are conditions present at birth that usually occur in children. This disease is very rare in adults. Approximately 35% of patients present with complaints of lower abdominal pain, signs of urinary tract infection, painful lumps in the abdomen, and hematuria. Here we present a case of A 27 year old woman came to the emergency unit with a lump in her stomach since 3 months before admitted to the hospital, located in the lower abdomen, the initial lump was the size of a marble, it got bigger over time and the patient felt feverish. The lump size was the size of a fist and burst open releasing pus and blood. This patient was diagnosed using CT-scan and Ultrasonography. This patient did not undergo any treatment, and chose to go home resulting in a loss to follow up. Urachal residual disease is a rare and manifests with nonspecific abdominal or urinary tract signs and symptoms. Although rare, disorders of the urachus can take the form of acute, life-threatening infections or malignant degeneration. It is important to carry out an accurate diagnosis and appropriate treatment. Urachal anomalies are rare in adults and often undiagnosed due to their nonspecific clinical course. Early diagnosis using several modalities such as ultrasonography and CT-Scan can help in planning an appropriate surgical intervention, thereby reducing morbidity.
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Affiliation(s)
- Basofi Sukiman
- Department of Radiology, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Leni Santiana
- Department of Radiology, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia
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2
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Tanaka A, Fujii T, Katami H, Ishikawa R, Haba R, Shimono R. Omphalomesenteric Ducts and Urachal Remnants: A Retrospective Study and Case Series. Cureus 2024; 16:e63877. [PMID: 39099973 PMCID: PMC11298018 DOI: 10.7759/cureus.63877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
PURPOSE The management strategies for umbilical disorders remain undefined. This study aims to review our experience and propose a management algorithm for symptomatic urachal and omphalomesenteric duct anomalies. METHODS We retrospectively reviewed medical charts between January 2013 and September 2017 of 28 patients with clinical concern for umbilical disorders, out of which 10 were diagnosed with omphalomesenteric duct remnants (OMDR) or urachal remnants (UR). We assessed patients' sex, age at operation, initial presentation, imaging findings, surgical approach, histopathological findings, and prognostic outcome. RESULTS Among 10 patients with OMDR or UR, initial presentations were omphalitis in four, umbilical discharge in three, abdominal pain in two, and umbilical mass in one. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and voiding cystourethrography were performed in 10, seven, three, and four patients, respectively. Transumbilical extraperitoneal excision from a small expanded umbilical incision and laparoscopic approach combined with transumbilical excision was performed in eight and two patients, respectively. Postoperative wound infection occurred in 10% of patients. DISCUSSION AND CONCLUSION Ultrasonography was mostly used as an initial diagnostic modality, and in cases in which there were signs of infection, they were drained adequately; CT/MRI was chosen for further evaluation of suspicious cases for other complications. Thus, we recommended surgical excision in cases with persistent umbilical disorders. The umbilical approach displays good cosmetic results with easy, complete excision, and the laparoscopic approach could be an excellent diagnostic and therapeutic method for the management of complicated conditions.
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Affiliation(s)
- Aya Tanaka
- Pediatric Surgery, Kagawa University, Takamatsu, JPN
| | | | - Hiroto Katami
- Pediatric Surgery, Kagawa University, Takamatsu, JPN
| | - Ryou Ishikawa
- Diagnostic Pathology, Kagawa University Hospital, Takamatsu, JPN
| | - Reiji Haba
- Diagnostic Pathology, Kagawa University Hospital, Takamatsu, JPN
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3
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Tanguturi Yella V, Tanguturi Yella SS, Kota KS, Tanguturi Yella SH, Thangaraju P. A Very Rare Disease of Patent Urachus Cyst With Vesico-Umbilical Urinary Fistula in Adults: A Case Report and Short Review. Cureus 2023; 15:e41503. [PMID: 37551248 PMCID: PMC10404365 DOI: 10.7759/cureus.41503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Krishna Sasanka Kota
- Ear, Nose and Throat (ENT) and Head and Neck Surgery (HNS), All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, IND
| | | | - Pugazhenthan Thangaraju
- Pharmacology and Therapeutics, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, IND
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4
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Bawahab MA. Laparoscopic management of symptomatic urachus remnants in adults: A retrospective study. J Minim Access Surg 2023; 19:217-222. [PMID: 37056087 PMCID: PMC10246646 DOI: 10.4103/jmas.jmas_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammed A. Bawahab
- Department of Surgery, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
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5
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Kamel K, Nasr H, Tawfik S, Azzam A, Elsaid M, Qinawy M, Kamal A, Taher H. Complicated urachal cyst in two pediatric patients: a case report. BMC Pediatr 2023; 23:147. [PMID: 37004016 PMCID: PMC10064585 DOI: 10.1186/s12887-023-03962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth. CASE PRESENTATION We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder. CONCLUSION Complicated urachal cysts can present with acute abdominal pain.
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Affiliation(s)
- Karol Kamel
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Hadeer Nasr
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Sherifa Tawfik
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Ahmed Azzam
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Mohamed Elsaid
- Faculty of Medicine, Misr University for Science and Technology, 6th of October, Giza, Egypt
| | - Mohamed Qinawy
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Ahmed Kamal
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Heba Taher
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt.
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Ellul S, Mizzi C, Gatt N, Galea J. Omphalomesenteric duct & Urachal remnant presentation in a newborn. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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7
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Acute urachal cystitis in two children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Perez D, Neeman B, Kocherov S, Jaber G, Armon Y, Zilber S, Chertin B. Current management of the urachal anomalies (UA). Lessons learned from the clinical practice. Pediatr Surg Int 2022; 38:1619-1623. [PMID: 35969254 DOI: 10.1007/s00383-022-05194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the clinical presentation, the efficacy of current modalities used, and postoperative pathology in patients with UA. MATERIALS AND METHODS We have performed a retrospective review of all patients diagnosed with UA and treated surgically or conservatively over 18 years. Demographic data, clinical presentation, imaging modalities, pathology, treatment, and postoperative complications were analyzed. RESULTS Twenty-five symptomatic patients (18 males and seven females) with a median age of 13 years (1 month to 37 years) were identified. 15 (60%) were diagnosed with a urachal cyst, 4 (16%) with sinus, 3 (12%) with urachal diverticulum, and the remaining 3 (12%) with patent urachus. Of those, 20 (80%) underwent surgical repair, and the remaining five (20%) patients were managed conservatively. 4 (20%) underwent laparotomy, 7 (35%) laparoscopic incision, and the remaining 9 (45%) laparoscopic robotic-assisted surgery. Nine patients required bladder cuff excision. The median operative time was 75 min (42-140 min). One patient developed Clavien-Dindo grade IIIA complication resulting in infected hematoma, which resolved after drainage. Another patient with a complication of grade IIIB needed reoperation as a result of recurrent events of an abscess. 13 (65%) demonstrated epithelium lining of the urachus on postoperative pathology. CONCLUSIONS Our data show that most of the patients with UA presented with epithelial lining, which might lead to the later malignant transformation. It might cause a shift from the conservative management of asymptomatic patients to surgical intervention. Robotic-assisted surgery appears beneficial in these patients, especially when the bladder cuff excision is required.
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Affiliation(s)
- Dolev Perez
- Department of Pediatric Urology, Shaare Zedek Medical Center, P.o.B 3235, 91031, Jerusalem, Israel.
| | - Binyamin Neeman
- Department of Pediatric Urology, Shaare Zedek Medical Center, P.o.B 3235, 91031, Jerusalem, Israel
| | - Stanislav Kocherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, P.o.B 3235, 91031, Jerusalem, Israel
| | - Gaudat Jaber
- Department of Pediatric Urology, Shaare Zedek Medical Center, P.o.B 3235, 91031, Jerusalem, Israel
| | - Yaron Armon
- Department of Pediatric Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sofia Zilber
- Department of Pathology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, P.o.B 3235, 91031, Jerusalem, Israel
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Zenitani M, Nose S, Oue T. Prevalence of urachal remnants in children according to age and their anatomic variants. Pediatr Surg Int 2022; 38:1495-1500. [PMID: 35879470 DOI: 10.1007/s00383-022-05183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The aim of this study was to elucidate the prevalence of urachal remnants in children in relation to patient age as well as to identify their anatomic variants, using a laparoscopic view. METHODS The medical records of 394 pediatric patients who underwent laparoscopic inguinal hernia repair were reviewed. Patients were divided into four groups based on their age at surgery. Using laparoscopic visualization, the presence and anatomic variants of urachal remnants were analyzed. RESULTS A urachal remnant was confirmed in 140 children (35.5%). Although the prevalence was significantly higher in the group of children aged < 1 year (63.2%) than in any other group, no significant difference in the prevalence was observed between the groups aged ≥ 1 year. In 42 cases (10.7%), the urachal remnant merged into the lateral umbilical ligament. CONCLUSIONS Our results suggest a recommendation of nonoperative management of asymptomatic urachal remnants, especially in patients less than 1 year of age due to its probable spontaneous resolution. Knowledge of the anatomic variants could improve the accuracy of diagnosis of urachal remnants and the comprehension of its structure and localization for the achievement of accurate and complete excision.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Satoko Nose
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
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10
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Kang S, Imura E, Kim YJ, Yoon SA, Lee JH, Park JW. Successful treatment of a patent urachus concurrent with pyocele in a newborn: A case report. Medicine (Baltimore) 2022; 101:e29187. [PMID: 35608419 PMCID: PMC9276366 DOI: 10.1097/md.0000000000029187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Susie Kang
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Erika Imura
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shin Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jin-Woo Park
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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11
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Nissen M, Rogge P, Sander V, Alrefai M, Romanova A, Tröbs RB. Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature. CHILDREN 2022; 9:children9010072. [PMID: 35053696 PMCID: PMC8774176 DOI: 10.3390/children9010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
Background: Surgery is the current mainstay for the treatment of urachal anomalies (UA). Recent literature data support the theory of a spontaneous resolution within the first year of life. The aim of this study, comprising solely surgically treated children, was to identify age specific patterns regarding symptoms and outcomes that may support the non-surgical treatment of UA. Methods: Retrospective review on the clinico-laboratory characteristics of 52 children aged < 17 years undergoing resection of symptomatic UA at our pediatric surgical unit during 2006–2017. Data was dichotomized into age > 1 (n = 17) versus < 1 year (n = 35), and complicated (pre-/post-surgical abscess formation or peritonitis, n = 10) versus non-complicated course (n = 42). Results: Children aged < 1 year comprised majority (67%) of cohort and had lower complication rates (p = 0.062). Complicated course at surgery exclusively occurred in patients aged > 1 year (p = 0.003). Additionally, complicated group was older (p = 0.018), displayed leukocytosis (p < 0.001) and higher frequencies regarding presence of abdominal pain (p = 0.008) and abdominal mass (p = 0.034) on admission. Regression analysis identified present abdominal pain (OR (95% CI), 11.121 (1.152–107.337); p = 0.037) and leukocytosis (1.435 (1.070–1.925); p = 0.016) being associated with complicated course. Conclusions: This study provides evidence that symptomatic disease course follows an age-dependent complication pattern with lower complication rates at age < 1 year. Larger, studies have to clarify, if waiting for spontaneous urachal obliteration during the first year of life comprises a reasonable alternative to surgery.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
- Correspondence: or ; Tel.: +49-23021733709; Fax: +49-23021731699
| | - Phillip Rogge
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Volker Sander
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Anna Romanova
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Group, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (P.R.); (V.S.); (M.A.); (A.R.)
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Johannes Hospital, Helios Group, An der Abtei 7-11, D-47166 Duisburg, Germany;
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12
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Olthof DC, Reemst S, Sleeboom C, Kuijper CF, van Schuppen J, Derikx JPM, Gorter RR. Diagnostic accuracy of abdominal ultrasound to detect pathology that needs surgical exploration in children with umbilical discharge. J Pediatr Surg 2021; 56:1436-1440. [PMID: 32951887 DOI: 10.1016/j.jpedsurg.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Umbilical discharge is common in children and mostly attributed to infection or granuloma. However, an underlying congenital abnormality warranting surgery might also be present. Ultrasound is the imaging modality of choice to diagnose the presence of a congenital abnormality. The aim of this study is to investigate diagnostic accuracy of the ultrasound to detect pathology requiring surgical excision. METHODS All patients ≤18 years with umbilical discharge from January 2008 to September 2019 were retrospectively included. Diagnostic accuracy, i.e., sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), were calculated. RESULTS Eighty-one patients were included and 56 were operated. The ultrasound was false positive in 10 patients and false negative in 13 patients. The sensitivity of ultrasound was 71.1% (95% CI 55.7-83.6), specificity 72.2% (54.8-85.8), PPV 76.2% (64.7-84.8), NPV 66.7% (54.8-76.8), LR+ 2.6 (1.5-4.5) and LR- 0.40 (0.2-0.7). CONCLUSIONS This study shows that the diagnostic accuracy of ultrasound for detecting underlying congenital abnormalities warranting surgery for umbilical discharge in the pediatric population is low, even with experienced pediatric radiologists. Therefore, the role of the ultrasound in the diagnostic workup and value in clinical decision making is limited. TYPE OF STUDY Study of diagnostic test. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Sophie Reemst
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - C F Kuijper
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - J P M Derikx
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - R R Gorter
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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13
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Osumah TS, Granberg CF, Butaney M, Gearman DJ, Ahmed M, Gargollo PC. Robot-Assisted Laparoscopic Urachal Excision Using Hidden Incision Endoscopic Surgery Technique in Pediatric Patients. J Endourol 2020; 35:937-943. [PMID: 32013581 DOI: 10.1089/end.2019.0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Although laparoscopic urachal excision in children has been well reported, there are limited data on a robot-assisted surgery (RAS) approach. The hidden incision endoscopic surgery (HIdES) technique is an established method of eliminating visible scars following a number of RAS urologic procedures. We report our experience of using a robotic approach to treat urachal anomalies in children, and we present the first description of utilizing the HIdES port configuration for this procedure. Materials and Methods: We retrospectively reviewed pediatric patients who underwent resection of a urachal remnant at our institution from 2013 to 2018. Surgical techniques were either the traditional open approach (OA) or RAS. HIdES trocar placement configuration was employed in all robotic cases. Patient demographics, perioperative data, pathology reports, and outcomes were abstracted and compared. Results: Twenty-three patients underwent a urachal remnant resection in the study period (RAS: 14 patients vs OA: 9 patients). RAS patients were older (8.5 vs 2.0 years, p = 0.031) and weighed more than OA patients (36.1 vs 13.9 kg, p = 0.063). Median operative time for RAS was longer than OA operative time (136 vs 33 minutes, p < 0.01). Fewer RAS patients were outpatient compared with OA (7.1% vs 66.7%, p < 0.01), but with a median length of stay of 1 day (0-1 day). Two patients (14.3%) in the RAS group experienced postoperative complications within 1 week of the procedure compared with 1 (11.1%) in the OA group. There was no significant difference in blood loss, postoperative narcotic requirements, or duration of follow-up between both groups. Conclusion: RAS is a safe and feasible alternative to open surgery for urachal anomalies. Complete excision can be achieved by using HIdES port configuration, allowing for excellent cosmetic outcomes that are superior to traditional surgical scars without limitation to essential surgical ergonomics.
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Affiliation(s)
| | | | - Mohit Butaney
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Ahmed
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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14
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Alaygut D, Soyaltin E, Camlar SA, Tekin A, Sayan A, Ozdemir T, Alparslan C, Mutlubas F, Yavascan O, Demir BK. Periumbilical swelling, erythema, and discharge in a girl: Answers. Pediatr Nephrol 2020; 35:411-413. [PMID: 31529155 DOI: 10.1007/s00467-019-04354-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/04/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Demet Alaygut
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey.
| | - Eren Soyaltin
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | | | - Ali Tekin
- Ege University, Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey
| | - Ali Sayan
- Tepecik Training and Research Hospital, Department of Pediatric Surgery, Izmir, Turkey
| | - Tunç Ozdemir
- Tepecik Training and Research Hospital, Department of Pediatric Surgery, Izmir, Turkey
| | - Caner Alparslan
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Fatma Mutlubas
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Onder Yavascan
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Belde Kasap Demir
- Katip Celebi University, Faculty of Medicine, Department of Pediatric Nephrology, Izmir, Turkey
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15
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Tanaka K, Misawa T, Baba Y, Ohashi S, Suwa K, Ashizuka S, Yoshizawa J, Ohki T. Surgical management of urachal remnants in children: open versus laparoscopic approach: A STROBE-compliant retrospective study. Medicine (Baltimore) 2019; 98:e17480. [PMID: 31577782 PMCID: PMC6783207 DOI: 10.1097/md.0000000000017480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Urachal remnants (UR) represent a failure in the obliteration of the allantois, which connects the bladder to the umbilicus, at birth. Surgical management of UR in children is controversial. The traditional surgical approach involves a semicircular intraumbilical incision or a lower midline laparotomy. Recently, many reports have supported the laparoscopic approach (LA) for removing UR. However, there is a paucity of data comparing the benefits of LA those of the open approach (OA).We retrospectively reviewed all children (aged ≤16 years) with UR who underwent surgical procedures. Age at surgery, sex, operative time, intraoperative or postoperative complications, total wound length, and length of hospital stay length after operation were analyzed.Overall, 30 children aged between 9 months and 16 years (mean 9.0 years) underwent surgical procedures: 15 were treated by OA and 15 were treated by LA. The only statistically significant variable was the operative time. Furthermore, we reanalyzed the age distributions of the older children (aged ≥10 years). In this group, no significant difference in the operative time between OA and LA was observed; however, there was a statistically significant difference in the total wound length.Our review indicated that LA required longer operative time than OA without any cosmetic advantage. However, in older children (aged ≥10 years), the difference in the operative time was not significant; moreover, LA provided greater cosmetic advantage. LA is recommended for older children (aged ≥10 years) because of its cosmetic advantage.
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Urachal anomalies: A review of pathological conditions, diagnosis, and management. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Early Outcomes of Laparoscopic Versus Open Surgery for Urachal Remnant Resection in Children: A Retrospective Analysis Using a Nationwide Inpatient Database in Japan. J Laparoendosc Adv Surg Tech A 2019; 29:1067-1072. [PMID: 31313966 DOI: 10.1089/lap.2019.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There was no large study that assessed the surgical safety of laparoscopic surgery (LS) for urachal remnant resection. This study compared early postoperative outcomes between LS and open surgery (OS) for pediatric urachal remnant resection, using a national inpatient database. Patients and Methods: Using the Diagnosis Procedure Combination database in Japan, we compared postoperative complications, duration of anesthesia, postoperative length of stay, and total hospitalization cost between LS and OS for children undergoing urachal remnant surgery from April 2015 to March 2017. Propensity score-adjusted analyses were performed for outcomes. Results: Among 882 eligible patients (306 LS; 576 OS), there were no significant differences between LS and OS for postoperative complications (odds ratio: 1.02; 95% confidence interval [CI]: 0.48-2.18; P = .96) and postoperative length of stay (difference: 0.14 day; 95% CI: -0.27 to 0.54; P = .39). Compared with OS, LS had significantly longer duration of anesthesia (difference: 51 minutes; 95% CI: 42-60; P < .001) and significantly higher total hospitalization cost (difference: US$824; 95% CI: 399-1249; P < .001). Conclusions: In this large nationwide cohort study, LS for urachal remnant resection was associated with longer duration of anesthesia and higher total hospitalization cost. However, no differences were detected between LS and OS regarding postoperative complications and length of stay. LS for urachal remnant resection is equivalent to OS in terms of surgical safety.
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Affiliation(s)
- Michimasa Fujiogi
- 1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- 3Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- 1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Dethlefs CR, Abdessalam SF, Raynor SC, Perry DA, Allbery SM, Lyden ER, Azarow KS, Cusick RA. Conservative management of urachal anomalies. J Pediatr Surg 2019; 54:1054-1058. [PMID: 30867097 DOI: 10.1016/j.jpedsurg.2019.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate trends in management of urachal anomalies at our institution and the safety of nonoperative care. METHODS Based on our experience managing urachal remnants from 2000 to 2010 (reported in 2012), we adopted a more conservative approach, including preoperative antibiotic use, refraining from using voiding cystourethrograms (VCUG), postponing surgery until at least six months of age, and considering nonoperative management. A retrospective analysis of urachal anomaly cases was conducted (2011-2016) to assess trends in practice. Charts indicating anomalies of the urachus were pulled and trends in management (nonoperative versus surgical treatment), VCUG and antibiotic use, and outcomes were reviewed. RESULTS Data from 2000-2010 and 2013-2016 were compared. Our findings indicate care has shifted towards nonoperative management. A smaller proportion of patients from 2013-2016 was treated surgically compared to 2000-2010. Patients receiving nonoperative treatment exhibited lower rates of complication relative to surgically managed cases. VCUGs were eliminated as a diagnostic tool for evaluating urachal anomalies. Prophylactic preoperative antibiotic use was standardized. No patients with a known urachal remnant presented later with an abscess or sepsis. CONCLUSIONS We find that a shift towards nonoperative treatment of urachal anomalies did not adversely affect overall outcomes. We recommend observing minimally symptomatic patients, especially those under six months old. STUDY TYPE Performance improvement. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christopher R Dethlefs
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE
| | - Sandra M Allbery
- Department of Radiology, Children's Hospital & Medical Center, Omaha, NE
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska College of Public Health. Omaha, NE
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE.
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Hassanbhai DH, Ng FC, Koh LT. Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution. Scand J Urol 2019; 52:432-436. [PMID: 30602341 DOI: 10.1080/21681805.2018.1534884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the ideal management of uncomplicated adult urachal remnants and to confirm if conservative management with repeated imaging is acceptable. PATIENTS AND METHODS This is a retrospective review of clinical notes and imaging of 45 patients with a mean age of 54.6 years who had been diagnosed with urachal anomalies at a single urology tertiary centre from January 2005 to December 2016. Patients who underwent surgical intervention and findings from patients managed non-operatively, with a mean follow up of 31 months, were evaluated. RESULTS Thirty (66.7%) patients had incidental findings, while 15 (33.3%) were symptomatic. Eight underwent excision, one underwent an incision and drainage of abscess, while 34 of the 36 remaining patients elected to undergo surveillance with repeated ultrasound imaging. Two were lost to follow-up. Malignancy was confirmed in three patients. There was interval stability of the urachal remnant in all the patients in the non-operative cohort. The small sample size, limited follow-up, and retrospective nature of the study are recognised limitations. CONCLUSIONS It was found that simple and asymptomatic lesions can be monitored with ultrasound, but effort must be made on initial diagnosis to ensure that malignancy is excluded using CT imaging and flexible cystoscopy where possible. Long-term follow-up of this cohort is required to assess the natural history of observed urachal anomalies.
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Affiliation(s)
| | - Foo Cheong Ng
- a Department of Urology , Changi General Hospital , Singapore , Singapore
| | - Li-Tsa Koh
- a Department of Urology , Changi General Hospital , Singapore , Singapore
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Bitar A, Hamzah A, Khan A. A rare case of prolapsed and everted bladder through a widely patent urachus with an absent omphalocele. UROLOGICAL SCIENCE 2019. [DOI: 10.4103/uros.uros_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Post TURBT Discovery of Urachal Remnant in a 62-Year-Old Man. Urology 2018; 122:13-15. [PMID: 30170092 DOI: 10.1016/j.urology.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 11/23/2022]
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Rhudd A, Moghul M, Nair G, McDonald J. Malignant transformation of a urachal cyst-a case report and literature review. J Surg Case Rep 2018; 2018:rjy056. [PMID: 30271532 PMCID: PMC6153322 DOI: 10.1093/jscr/rjy056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022] Open
Abstract
Urachal remnant diseases are very uncommon pathologies which are mostly benign. Rarely they can progress to a very aggressive form of Urachal cancer. The rarity of this condition has precluded large studies to help guide the diagnostic and therapeutic management of these potentially malignant lesions. In this case, a urachal cyst was discovered and conservative management was employed after a biopsy proved the lesion was benign. Unfortunately this patient represented several years later with a locally advanced urachal cancer. To date, this is the first clearly documented case of malignant transformation. The available literature surrounding these urachal cysts and cancers will be reviewed to determine if anything could have been done differently in this case and in the future should a similar case present.
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Affiliation(s)
- Adrian Rhudd
- Department of Urology, University of the West Indies, Mona, Jamaica
- North Middlesex University Hospital NHS Trust, Sterling Way, London, UK
- Correspondence address. Department of Urology, North Middlesex University Hospital NHS Trust, Sterling Way, London N181QX, UK. Tel: +44-20-88-87-2000; E-mail:
| | - Masood Moghul
- North Middlesex University Hospital NHS Trust, Sterling Way, London, UK
| | - Gopal Nair
- North Middlesex University Hospital NHS Trust, Sterling Way, London, UK
| | - Jean McDonald
- North Middlesex University Hospital NHS Trust, Sterling Way, London, UK
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Hassan S, Koshy J, Sidlow R, Leader H, Horowitz M. To excise or not to excise infected urachal cysts: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Tumors arising from urachus in children are exceedingly rare and sporadically reported in literature. Being a midline structure, the urachus may harbor neoplastic germ cell elements and can occasionally present as a case of acute abdomen. A 20-month-old toddler presented with spontaneous rupture of an urachal yolk sac tumor causing hemoperitoneum. He underwent resection, received platinum-based chemotherapy and presently remains well on follow-up. Despite its rarity, urachal germ cell tumors must be considered in a child with acute abdomen and tumor markers must be measured preemptively in such cases.
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[THE OPTIMAL TROCAR PLACEMENT FOR LAPAROSCOPIC EXCISION OF URACHAL REMNANTS]. Nihon Hinyokika Gakkai Zasshi 2017; 108:182-187. [PMID: 30333439 DOI: 10.5980/jpnjurol.108.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) Although laparoscopic excision of urachal remnants has been applied widely, the standard surgical method has yet to be established. The aim of this study, therefore, was to evaluate perioperative outcome and surgical techniques, including the trocar placement at our institution. (Subjects and methods) A total of 20 patients with urachal remnant were treated using laparoscopic surgery between October 2002 and August 2016. 3 trocars were inserted in the peritoneal cavity. Camera trocar was placed at right side of umbilicus and two working trocars were placed at the upper side of umbilicus and right lower quandrant. A 5 mm, 30° angled lens camera was used during operation. (Results) The mean age was 27 years old. There were 16 males and 4 females. The classifications of urachal remnants were urachal sinus (n=18) and urachal diverticulum (n=2). Umbilical excision was performed in 18 case and partial cystectomy were required in 4 cases. 4 trocars were inserted in only one case due to severe adhesion in the peritoneal cavity. Laparoscopic excision was successfully completed in all cases. The mean operative time was 220 minutes and the mean blood loss was minimal. The complications occurred in 5 cases including small intestinal injury (n=2), peritonitis (n=1), wound infection (n=1), intestinal obstruction (n=1) and acute renal failure (n=1) (intestinal obstruction and acute renal failure were occurred in the same case). (Conclusion) Although there are problems such as shortening the operative time and reducing complications, our unique port placement enables good surgical view and easy suturing during partial cystectomy.
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Abstract
BACKGROUND The urachus and the urachal remnants represent a failure in the obliteration of the allantois at birth that connects the bladder to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Urachal cyst are the most common urachal anomaly in the pediatric population. The traditional surgical approach is a semicircular infraumbilical incision or a lower midline laparotomy. METHODS In a 10 years period at Pediatric Surgery Department of Vicenza 16 children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms. Eight underwent open excision; eight were treated by laparoscopic surgery. The average age was 5.5 years (range, 4 months-13 years) in open group and 10 years (range, 1 month-18 years) in laparoscopic group. RESULTS Mean operative time was 63 minutes (range, 35-105 minutes) in open group, 50 minutes (range, 35-90 minutes) in laparoscopic group. There were no postoperative complications. The patients of laparoscopic group were all discharged after few days (range, 2-4 days). Pathological examination confirmed a benign urachal remnant in all cases. Reporting our experience since comparing the two surgical approaches we want to describe the technique step by step of laparoscopic urachal cyst excision as minimally invasive diagnostic and surgical techniques. CONCLUSIONS Laparoscopy represents a useful alternative for the management of persistent or infected urachus, in particular when there's the suspect despite the lack of radiological evidence. The morbidity associated with this approach is very low as the risk or recurrence. Laparoscopy in the management of urachal cyst is safe effective and ensures good cosmesis with all the advantages of minimally invasive approach.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
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Kwok CM. Infected Urachal Cyst in an Adult: A Laparoscopic Approach. Case Rep Gastroenterol 2016; 10:269-74. [PMID: 27462196 PMCID: PMC4939676 DOI: 10.1159/000446642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/04/2016] [Indexed: 11/19/2022] Open
Abstract
Urachal cysts occur infrequently in adults and are rarely reported in the literature. Laparoscopic excision or robot-assisted laparoscopic excision of urachal cysts has widely been applied in recent years. We present a case of urachal cyst infection treated with antibiotics and two-staged operation. The laparoscopic procedure was performed without any complications. Strong suspicion is the key for early diagnosis.
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Affiliation(s)
- Ching-Ming Kwok
- Division of General Surgery, Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan; National Yang Ming University School of Medicine, Taipei, Taiwan
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de Queiroz Garcia M, de Queiroz Garcia M, Barral CM. Patent Urachus Presenting as Acute Abdomen. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Massive pyuria as an unusual presentation of giant infected urachal remnant in a child. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000471681.37576.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Stopak JK, Azarow KS, Abdessalam SF, Raynor SC, Perry DA, Cusick RA. Trends in surgical management of urachal anomalies. J Pediatr Surg 2015; 50:1334-7. [PMID: 26227313 DOI: 10.1016/j.jpedsurg.2015.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE We have noted an increasing frequency of diagnosed urachal anomalies. The purpose of this study is to evaluate this increase, as well as the outcomes of management at our institution over 10 years. METHODS A retrospective analysis of urachal anomalies at our institution was performed. Inclusion criteria were Anomalies of Urachus (ICD 753.7) or Urinary Anomaly NOS (ICD 753.9) between January 2000 and December 2010. Exclusion criteria were having an asymptomatic urachal remnant incidentally excised. RESULTS Eighty-five patients (49 male, 36 female) presented between 0 and 17 years of age (mean 1.5 years). Diagnoses increased from 0 in 2000 to 21 in 2010. Zero was surgically managed in 2000 while 21 were managed in 2010 (p=0.0145). Fifteen patients (17.6%) were observed with 13 (13/15, or 15.3%) resolving without complication while 2 were operated on. Average time to resolution (clinical or radiologic) was 4.9 months (Range: 0.4-12.6). A total of seventy-two patients (84.7%) underwent excision. Thirty-nine (54%) surgical cases were outpatient while 33 (46%) were admitted. Thirteen (18%) had post-operative complications. Ten (77%) of the complications were wound infections. Patients under 6 months of age accounted for 60% (6 of 10) of all wound infections and 52% (17 of 33) of hospitalizations. CONCLUSIONS Our experience and review of the literature suggest a high complication rate with surgical management in young patients, mostly from infections and support non-operative management of all non-infected urachal remnants in children.
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Affiliation(s)
- Joshua K Stopak
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE, 68114, USA
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
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Heuga B, Mouttalib S, Bouali O, Juricic M, Galinier P, Abbo O. [Management of urachal remnants in children: Is surgical excision mandatory?]. Prog Urol 2015; 25:603-6. [PMID: 26094100 DOI: 10.1016/j.purol.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The classical management of urachal remants consists in surgical resection, in order to prevent infections and long term malignancies. However, some reports have recently spread a wait and see management. The aim of our study was to report the results of the surgical management in our center. MATERIAL AND METHODS We conducted a retrospective, monocentric review of all patients managed for urachal remnants from January 2005 to December 2014. RESULTS Thirty-five patients have been operated during the study period (18 girls and 17 boys). Mean age at surgery was 4,9±4,4 years old. Twenty-seven patients were referred due to symptoms whereas 8 were discovered incidentally (4 by ultrasound scan and 4 during laparoscopy). Among them, 10 were urachal cysts, 15 were urachus sinusa and 10 were patent urachus. Thirty were operated using an open approach and 5 using a laparoscopic approach. Mean length of stay was 3,8±1,7days (1-10) with a mean duration of bladder drainage of 2,5±1 days. No major complications occurred. No abnormal tissue was discovered at the histological analysis. CONCLUSION Presentation of urachal remnants is variable but surgical outcomes remain excellent in our experience. When symptoms occur, the surgical decision is easy, but when the diagnosis is incidental, the decision is much more complicated. Official guidelines could ease the decision process and the management of urachal anomalies.
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Affiliation(s)
- B Heuga
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - S Mouttalib
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - O Bouali
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - M Juricic
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - P Galinier
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - O Abbo
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
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Rivera M, Granberg CF, Tollefson MK. Robotic-Assisted Laparoscopic Surgery of Urachal Anomalies: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2015; 25:291-4. [DOI: 10.1089/lap.2014.0551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Siow SL, Mahendran HA, Hardin M. Laparoscopic management of symptomatic urachal remnants in adulthood. Asian J Surg 2015; 38:85-90. [DOI: 10.1016/j.asjsur.2014.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/18/2014] [Accepted: 04/24/2014] [Indexed: 12/26/2022] Open
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Intestinal obstruction caused by a Meckel’s diverticulum adherent to an infected urachal cyst. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000452060.45944.c5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bertozzi M, Riccioni S, Appignani A. Laparoscopic Treatment of Symptomatic Urachal Remnants in Children. J Endourol 2014; 28:1091-6. [DOI: 10.1089/end.2014.0203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Nogueras-Ocaña M, Rodríguez-Belmonte R, Uberos-Fernández J, Jiménez-Pacheco A, Merino-Salas S, Zuluaga-Gómez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol 2014; 10:522-6. [PMID: 24321777 DOI: 10.1016/j.jpurol.2013.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/06/2013] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Mercedes Nogueras-Ocaña
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain.
| | | | | | - Antonio Jiménez-Pacheco
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Sergio Merino-Salas
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Armando Zuluaga-Gómez
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
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Mador BD, Blair GK. Pediatric Crohn disease complicated by an entero-uracho-cutaneous fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kingo PS, Høyer S, Marinovskij E, Rawashdeh YF. Paediatric urachal benign teratoma: a case report and review of the literature. APMIS 2014; 122:761-5. [PMID: 24475742 DOI: 10.1111/apm.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
Urachal anomalies are most often seen in children, seldom in adults, but are in general considered rare. The estimated incidence is one in 5000-7000 live births and appears twice as common in males. Despite their rarity, they need to be considered by clinicians, as diseases in the urachus can mimic many abdominal and pelvic conditions and constitute an important differential diagnosis to these. Diagnosis can be made by clinical examination and imaging modalities (computed tomography, ultrasonography, magnetic resonance imaging, voiding cystourethrogram), but some are discovered incidentally. Management of symptomatic urachal anomalies is surgery. Histological examination of the specimen should always be performed to rule out malignancy. We report on the first adolescent described in the literature diagnosed with a urachal sinus harboring a benign teratoma. A combination of the two pathologies is by inference an extremely rare condition, which we here report on and we review the relevant literature on this topic.
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Naiditch JA, Radhakrishnan J, Chin AC. Current diagnosis and management of urachal remnants. J Pediatr Surg 2013; 48:2148-52. [PMID: 24094971 DOI: 10.1016/j.jpedsurg.2013.02.069] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/30/2013] [Accepted: 02/27/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study are to review our experience with patients who were found to have urachal remnants. We discuss their diagnosis and management and we also evaluate post-operative complications in our cohort of patients with this entity. METHODS We performed a retrospective review of all patients diagnosed with a urachal remnant (UR) between January 2006 and December 2010. Patient variables included age, gender, presenting symptoms and signs, diagnostic modality, and type of urachal remnant. Operative management, post-operative complications, and non-operative follow-up were abstracted. RESULTS We identified 103 pediatric patients with either a urachal cyst (n = 38), urachal diverticulum (n = 13), urachal sinus (n = 11), patent urachus (n = 21), or a non-specific atretic urachal remnant (n = 20). Seventy-eight patients had symptomatic URs. Thirty-four symptomatic patients underwent surgical excision of the UR and 44 symptomatic patients were observed. Eighteen URs were incidentally diagnosed in asymptomatic patients, none of whom underwent surgical excision. In 7 patients symptoms could not be determined from the records. No patients with non-specific atretic remnants were operated upon. Nineteen of the observed patients were reimaged subsequently. In fifteen (78.9%) of these patients, the URs had resolved spontaneously. None of the patients who were observed required subsequent excision of the UR. Post-operative complications occurred in 14.7% of patients in whom URs were excised. CONCLUSION Review of our patients diagnosed with URs indicates there is a subset of patients in whom spontaneous resolution could be expected. Complications are not uncommon after surgical excision.
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Affiliation(s)
- Jessica A Naiditch
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wang B, Tashiro J, Pelaez L, Rodriguez MM, Perez EA, Neville HL, Sola JE. A unique presentation and rare pathological finding for urachal sinus. J Pediatr Surg 2013; 48:1977-80. [PMID: 24074678 DOI: 10.1016/j.jpedsurg.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
We report an otherwise well developing 2-year-old girl who presented with a urachal sinus with its opening located at the midline between umbilicus and the pubic symphysis. Diagnosis was made by ultrasound preoperatively, and confirmed during surgery. Additionally, columnar epithelium was found in the portion of sinus tract traversing the abdominal wall. Metaplasia of the sinus tract is worrisome, as urachal carcinomas have been traditionally characterized to result from this process.
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Affiliation(s)
- Bo Wang
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, Miami, FL 33136, USA
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Lane V, Patel R, Daniel RD. Prolapsed urachal sinus with pyourachus in an infant. J Pediatr Surg 2013; 48:e17-9. [PMID: 23480942 DOI: 10.1016/j.jpedsurg.2012.12.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/27/2012] [Accepted: 12/05/2012] [Indexed: 02/05/2023]
Abstract
We report an infant who presented with a discharging single-lumen, tubular, and mucosa-lined umbilical mass and a large central abdominal mass, inferior to the umbilicus. At operation, the mass was discovered to be a prolapsed, open, and inflamed urachal sinus leading to a pyourachus. Primary total excision from dome of the bladder to the umbilicus led to smooth recovery with excellent results.
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Affiliation(s)
- Victoria Lane
- Department of Paediatric Surgery, Children's Hospital, University Hospitals of Hull and East Yorkshire NHS Trust, Hull Royal Infirmary, HU3 2JZ Hull, UK
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Affiliation(s)
- Matthew Fink
- Division of Dermatology and Cutaneous Surgery and Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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[Laparoscopic treatment of urachal remnants]. Actas Urol Esp 2012; 36:320-4. [PMID: 22014387 DOI: 10.1016/j.acuro.2011.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/15/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology. MATERIAL AND METHODS Three male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch. RESULTS Mean operating time was 94 min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No post-operative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence. CONCLUSIONS Urachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment.
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Fox JA, McGee SM, Routh JC, Granberg CF, Ashley RA, Hutcheson JC, Vandersteen DR, Reinberg YE, Kramer SA. Vesicoureteral reflux in children with urachal anomalies. J Pediatr Urol 2011; 7:632-5. [PMID: 21565560 DOI: 10.1016/j.jpurol.2011.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA). METHODS Two institutions' records were reviewed for children with UA (1951‒2007). RESULTS Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously. CONCLUSION To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.
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Affiliation(s)
- Janelle A Fox
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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Infection d’un résidu ouraquien : cause de douleur abdominale atypique. Arch Pediatr 2011; 18:874-6. [DOI: 10.1016/j.arcped.2011.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 06/10/2010] [Accepted: 05/09/2011] [Indexed: 11/21/2022]
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49
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Abstract
Urachal cyst complications requiring surgical intervention are rarely seen in adults, because the urachus is normally obliterated in infancy. Necrotizing fasciitis due to an infected urachal cyst in an adult female has not been reported. We describe the case of a fifty-year-old female who required aggressive surgical management of abdominal wall necrotizing soft tissue infection from an infected urachal cyst.
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Sun J, Zhu YJ, Shi CR, Zhao HT, He R, Liu GH. Laparoscopic Radical Excision of Urachal Remnants with Recurrent Infection in Infants. J Endourol 2010; 24:1329-32. [PMID: 20629568 DOI: 10.1089/end.2009.0141] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jie Sun
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Ying Jian Zhu
- Department of Urology, Shanghai First People's Hospital, Shanghai, China
| | - Cheng Ren Shi
- Department of Pediatric Surgery, Xin Hua Hospital, Shanghai, China
| | - Hai Teng Zhao
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Rong He
- Department of Urology, Shanghai Children's Medical Center, Shanghai, China
| | - Guo Hua Liu
- Department of Urology, Shanghai First People's Hospital, Shanghai, China
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