51
|
Gregory GC, Vijay R, Ligaj M, Shiwani MH. Laparoscopic management of urachal cyst associated with umbilical hernia. Hernia 2010; 15:93-5. [PMID: 20069440 DOI: 10.1007/s10029-009-0618-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 12/22/2009] [Indexed: 11/27/2022]
Abstract
The urachal cyst is a rare clinical entity of a urachal remnant. It is usually asymptomatic but can present with haematuria, tumour, urachal stone and infection. We present a case of a 63-year-old lady with a body mass index (BMI) of 49 who presented with a painful swelling in the umbilical region associated with an umbilical hernia. An ultrasound and computed tomography (CT) scan showed a suspected herniation of an umbilical remnant cyst through a paraumbilical defect. Laparoscopy confirmed the urachal cyst of 3 cm in size with a band connected with the cyst down to the urinary bladder associated with a 3-cm paraumbilical hernia. We removed the cyst and repaired the hernia laparoscopically uneventfully, after which her recovery was perfect. Radiological and laparoscopic pictures have not been reported in the English literature before. Although this condition is very rare, we suggest that it should be considered in the differential diagnosis of painful paraumbilical swelling. CT scanning and laparoscopy seems to be valuable, especially in obese patients.
Collapse
Affiliation(s)
- G C Gregory
- Department of General Surgery, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2EP, UK
| | | | | | | |
Collapse
|
52
|
Guillot P, Renard O, Robert G, Ferrière JM, Beylot-Barry M, Doutre MS. [Urachal sinus presenting as umbilical drainage in an adult male]. Ann Dermatol Venereol 2009; 136:536-9. [PMID: 19560617 DOI: 10.1016/j.annder.2009.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 02/20/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although urachal remnants are very rare, dermatologists must be aware of them in order to ensure suitable treatment by urologists. Lack of appropriate treatment exposes patients to the risks of recurrent infectious complications or degeneration to vesical adenocarcinoma. CASE REPORT A 32-year-old man consulted for mild and recurring umbilical weeping for approximately 1 year. He had previously undergone unsuccessful treatment, comprising application of liquid nitrogen and of silver nitrate to an umbilical lesion measuring several millimetres regarded as pyogenic granuloma. The diagnosis of urachal sinus was suspected clinically (umbilical weeping or inflammation) and confirmed by urological scan. DISCUSSION A defect involving partial or total obliteration of the urachal canal after the fifth month of gestation can result in four types of benign abnormalities. Patent urachus (50%) is diagnosed during the neonatal period, while in adults, the most frequent form is a urachal cyst (30%), with sinuses (15%) and the diverticula (5%) being very rare. The urachus and its implantation base on the bladder must be removed surgically. Laparoscopic surgery offers a valuable alternative to open-surgery and probably leads to less morbidity and shorter convalescence in active young subjects.
Collapse
Affiliation(s)
- P Guillot
- Service de dermatologie, hôpital du Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France. patrick.guillotWchu-bordeaux.fr
| | | | | | | | | | | |
Collapse
|
53
|
Yamzon J, Kokorowski P, De Filippo RE, Chang AY, Hardy BE, Koh CJ. Pediatric robot-assisted laparoscopic excision of urachal cyst and bladder cuff. J Endourol 2008; 22:2385-8; discussion 2388. [PMID: 18937602 DOI: 10.1089/end.2008.0338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Urachal cysts are the most common urachal anomaly in the pediatric population. There is an increasing body of literature documenting successful management of urachal cysts using laparoscopic techniques. There may be an advantage, however, with the use of robot-assisted laparoscopy for reconstructive cases. We describe the techniques used for robot-assisted laparoscopic excision of a urachal cyst and bladder cuff with bladder repair in a female child. This approach is a safe and effective option for the minimally invasive management of pediatric urachal cysts.
Collapse
Affiliation(s)
- Jonathan Yamzon
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, and Division of Pediatric Urology, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA
| | | | | | | | | | | |
Collapse
|
54
|
Renard O, Robert G, Guillot P, Pasticier G, Roche JB, Bernhard JC, Azizi A, Ferrière JM, Wallerand H. Pathologies bénignes de l’ouraque chez l’adulte : origine embryologique, présentation clinique et traitements. Prog Urol 2008; 18:634-41. [DOI: 10.1016/j.purol.2008.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/20/2008] [Accepted: 04/30/2008] [Indexed: 10/21/2022]
|
55
|
Galati V, Donovan B, Ramji F, Campbell J, Kropp BP, Frimberger D. Management of Urachal Remnants in Early Childhood. J Urol 2008; 180:1824-6; discussion 1827. [DOI: 10.1016/j.juro.2008.03.105] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Vincenzo Galati
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ben Donovan
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Faridali Ramji
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jeffrey Campbell
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Bradley P. Kropp
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dominic Frimberger
- Departments of Urology and Radiology (BPK), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
56
|
Abstract
Urachal diseases are infrequent. Congenital affections include cysts, fistula, diverticulum, external sinus, and alternating drainage sinus. Ultrasonography and fistulography are useful for the diagnosis. Treatment of malformations is rarely conservative; it consists in urachal resection. Urachal tumours are frequently malignant and adenocarcinomas are the main histological form. CT scanning is useful for staging. Treatment of urachal carcinomas consists in urachal, umbilicus and bladder removal. Prognosis is poor.
Collapse
|
57
|
Yapo BR, Gerges B, Holland AJA. Investigation and management of suspected urachal anomalies in children. Pediatr Surg Int 2008; 24:589-92. [PMID: 18357457 DOI: 10.1007/s00383-008-2136-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
Abstract
Urachal anomalies occur infrequently, but may be associated with morbidity, particularly when the diagnosis has been delayed. We retrospectively reviewed our institution's experience over a 10-year and 7-month period in the investigation and management of suspected urachal anomalies. There were 25 children between November 1995 and June 2006, who presented with a suspected urachal anomaly. The mean age was 12 months (range 3 days to 13 years); 14 were male. Presentations included granulomatous polyp (16), umbilical discharge (4), umbilical sepsis (2) and abdominal pain (2). One case was diagnosed incidentally during a renal ultrasound scan (US). The main investigative tool was US (10), followed by micturating cystourethrogram (2). Of the 25 children, 12 had a patent urachus confirmed by subsequent further imaging or surgery. Our review suggests that whilst clinical examination remains important in the management of a child presenting with a possible urachal pathology, in 36% of the cases the correct diagnosis was only made with further radiological imaging or at operation. Surgical excision was effective with no morbidity or mortality.
Collapse
Affiliation(s)
- B R Yapo
- Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, NSW, 2145, Australia
| | | | | |
Collapse
|
58
|
Yiee JH, Garcia N, Baker LA, Barber R, Snodgrass WT, Wilcox DT. A diagnostic algorithm for urachal anomalies. J Pediatr Urol 2007; 3:500-4. [PMID: 18947803 DOI: 10.1016/j.jpurol.2007.07.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 07/30/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Urachal anomalies are rare. Variable presentations can be a diagnostic challenge. We combine our series with a review of literature to delineate the most common presentations, highest yield diagnostic studies and a diagnostic algorithm. METHODS We reviewed records of 22 boys and 15 girls with the diagnosis of a urachal anomaly from 2000 through 2005. This revealed 19 cysts, seven patent urachuses, five sinuses, four patients with unspecified "urachal anomalies," and two patients with no urachal anomaly by surgical exploration. Ultrasound was the most common diagnostic study, followed by computed tomography (CT), voiding cystourethrogram and sinogram. Thirty-five of 37 patients underwent surgery. RESULTS Clinical presentation included periumbilical leakage in 54%, pain in 30%, periumbilical mass in 22% and irritative voiding symptoms in 14%. In many patients diagnosis was made on clinical examination alone. When an ultrasound was used it was diagnostic for 82% of cysts, 100% of sinuses and 100% of patent urachuses. A voiding cystourethrogram was diagnostic for 100% of patent urachuses, but less successful in the other anomalies. CT scans correctly diagnosed 71% of cysts. Overall complication rate was 9%, all wound infections. CONCLUSION Reviewing the results of this and four other large series showed that the most common anomaly is the urachal cyst followed by urachal sinus and patent urachus. Periumbilical drainage is the most common presentation. Physical exam alone can be diagnostic. When this is not possible ultrasound is our recommended initial study, followed by a CT scan if unsuccessful.
Collapse
Affiliation(s)
- Jenny H Yiee
- Department of Urology, University of California Los Angeles, 650 Charles Young Drive, Los Angeles, CA 90095-1738, USA.
| | | | | | | | | | | |
Collapse
|
59
|
Fernández EMLT, Siverio NH, Almaraz RL, Viota LM, Luis JR, Flores LD. Radical surgery and IVA-chemotherapeutic regimen to treat embryonal rhabdomyosarcoma of the urachus: case report. Pediatr Hematol Oncol 2007; 24:543-50. [PMID: 17786791 DOI: 10.1080/08880010701533678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although rhabdomyosarcoma is the most frequent soft tissue tumor in children, there are extremely few reports of this tumor arising from the urachus. The authors describe another case in a 6-year-old female associated with constipation and a painless suprapubic mass. The specimen had the pathological criteria used to define urachal sarcoma (cytological, histological, and immunohistochemical findings) and urachal remnants were not observed. After complete resection of the primary tumor the patient was treated with chemotherapy (ifosfamide, vincristine, and dactinomycin) and remains alive at 4 years' follow-up with no signs of recurrence. Nowadays the management of children with urachal rhabdomyosarcoma usually includes surgery and chemotherapy. Multimodal therapy and surgery are constantly evolving and have significantly improved overall survival of these patients especially in R0 resected patients.
Collapse
|
60
|
Hsu HC, Yang CH, Kuo TT, Shih IH, Hong HS. Urachal duct remnant-like umbilical clear cell acanthoma in an infant: an unusual presentation and pitfall in clinical practice. Int J Dermatol 2007; 46:615-8. [PMID: 17550563 DOI: 10.1111/j.1365-4632.2007.03051.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although an umbilical nodule is common in neonates and young infants, an umbilical nodule of poor therapeutic response will increase the likelihood of other uncommon etiology. Clear cell acanthoma (CCA) has never been described as an oozing umbilical nodule on infants. METHODS To present a case of CCA which occurred on an 8-month-old female infant presenting with one weeping nodule on the umbilicus since early neonate. The lesion underwent skin biopsy and subsequent hematoxylin-eosin and periodic acid-Schiff staining. RESULT Three courses of liquid nitrogen cryosurgery were performed after the diagnosis of CCA was confirmed. The lesion resolved rapidly. CONCLUSION This report presents the first and youngest case of umbilical CCA in the English literature. This case supports the inflammatory dermatosic nature of CCA.
Collapse
Affiliation(s)
- Hsiu-cheng Hsu
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
61
|
Carlisle EM, Mezhir JJ, Glynn L, Liu DC, Statter MB. The umbilical mass: a rare neonatal anomaly. Pediatr Surg Int 2007; 23:821-4. [PMID: 17641925 DOI: 10.1007/s00383-007-1883-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
Umbilical anomalies are a rare presentation in the pediatric patient. The differential diagnosis includes anomalies resulting from urachal and vitelline duct derivatives such as urachal sinus, urachal cyst, urachal diverticulum, patent urachus, herniated Meckel's diverticulum, umbilico-enteric fistula, or umbilical polyp. In this article, a case presentation of an umbilical anomaly along with the differential diagnosis and management options are discussed. Based upon this review of the literature, the authors propose a management algorithm for treating children with umbilical anomalies.
Collapse
Affiliation(s)
- Erica M Carlisle
- Department of Surgery, Section of Pediatric Surgery, The University of Chicago, 5839 S. Maryland Avenue, MC 4062, Chicago, IL 60637, USA
| | | | | | | | | |
Collapse
|
62
|
Linklater DR, Shook JE. Images in Emergency Medicine. Ann Emerg Med 2007; 50:199, 210. [PMID: 17643855 DOI: 10.1016/j.annemergmed.2007.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 12/18/2006] [Accepted: 01/04/2007] [Indexed: 11/28/2022]
Affiliation(s)
- Derek R Linklater
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
63
|
Turial S, Hueckstaedt T, Schier F, Fahlenkamp D. Laparoscopic Treatment of Urachal Remnants in Children. J Urol 2007; 177:1864-6. [PMID: 17437837 DOI: 10.1016/j.juro.2007.01.049] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE Urachal remnants are generally treated with the open method. We evaluated the role of laparoscopy for this anomaly in a consecutive series of 27 children treated during a 12-year period. MATERIALS AND METHODS A total of 27 children with a median age of 4.7 years presented with urachal remnants between 1993 and 2006. Two different laparoscopic approaches were used. In the first 9 children a 5 mm laparoscope was inserted at the umbilicus, with working trocars in the left and right upper abdominal wall. In the remaining patients the laparoscope was placed at the left lower abdominal wall, with working ports placed at the left lower and upper abdomen. The working ports were 2 mm trocars. The urachal remnants were ligated and excised by electrocautery, and the bladder-sided stump was ligated with 2 sutures. No drains were used. The specimen were exteriorized via the umbilicus. RESULTS Median operative time was 35 minutes. There were no intraoperative or postoperative complications, and no recurrences. Cosmetic results were excellent. CONCLUSIONS The laparoscopic approach for urachal remnants is safe, allows for better visualization of the anatomy and yields a cosmetic result that is superior to the open approach.
Collapse
Affiliation(s)
- Salmai Turial
- Department of Pediatric Surgery, University Medical Center Mainz, Mainz, Germany.
| | | | | | | |
Collapse
|
64
|
Abstract
Urachal remnants are uncommon congenital anomalies of the bladder that can be injured during attempted catheterization of an umbilical artery or vein. We present the case of a newborn boy who developed urinary ascites after undergoing an attempted umbilical vein catheterization. He subsequently underwent successful surgical repair of a perforated urachal remnant.
Collapse
Affiliation(s)
- Peter Mattei
- General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| |
Collapse
|
65
|
Abstract
Prenatally, the umbilicus is of paramount importance, providing the gateway between the mother and the fetus. As the fetus becomes increasingly autonomous at the end of the second month of fetal life, the connections (vitelline, urachal) diminish in significance and involute. Disturbances in this process can result in a wide variety of abnormalities, ranging from relatively minor defects identified at birth (umbilical granulation tissue) to life-threatening complications quiescent until late adulthood (urachal carcinoma). This section will review the 'state of the art' in evaluation and management of these umbilical and related abnormalities.
Collapse
Affiliation(s)
- Charles L Snyder
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
| |
Collapse
|
66
|
Vieira Júnior EDS, Abreu RAAD, Speranzini MB. Cisto de úraco em adultos simulando abdômen agudo. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
67
|
Kim DY, Park SG, Lee JH, Kim YC, Lee KH. A case of cutaneous ciliated cyst on the umbilicus mimicking omphalomesenteric duct cyst and urachal cyst. J Eur Acad Dermatol Venereol 2007; 20:1161-2. [PMID: 16987293 DOI: 10.1111/j.1468-3083.2006.01661.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
68
|
Kranbuhl KH, Lucky AW, Warner BW, Miles L, Bove KE. Combined omphalomesenteric and urachal remnants in an 18-month-old girl. Pediatr Dermatol 2007; 24:65-8. [PMID: 17300654 DOI: 10.1111/j.1525-1470.2007.00337.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A toddler with a persistent congenital umbilical papule is described. The papule was found to contain both omphalomesenteric and urachal remnants. This patient's findings illustrate the importance of further evaluation of umbilical lesions when conventional therapy with silver nitrate fails.
Collapse
Affiliation(s)
- K Helen Kranbuhl
- The Division of Pediatrics, The Clinical Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | | | | | | | | |
Collapse
|
69
|
Abstract
The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.
Collapse
Affiliation(s)
- Youn Joung Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Min Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Ahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Tak Oh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
70
|
Abstract
The urachus is a fibrous cord that arises from the anterior bladder wall and extends cranially to the umbilicus. Traditionally, infection has been treated using a two-stage procedure that includes an initial incision and drainage which is then followed by elective excision. More recently, it has been suggested that a single-stage excision with improved antibiotics is a safe option. Thus, we intended to compare the effects of the two-stage procedure and the single-stage excision. We performed a retrospective review on nine patients treated between May 1990 and September 2005. The methods used in diagnosis were ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and cystoscopy. The study group was comprised of three males and six females with a mean age of 28.2 years (with a range from three to 71 years). Symptoms consisted of abdominal pain, abdominal mass, fever, and dysuria. The primary incision and drainage followed by a urachal remnant excision with a bladder cuff excision (two-stage procedure) was performed in four patients. The mean postoperative hospitalization lasted 5.8 days (with a range of three to seven days), and there were no reported complications. A primary excision of the infected urachal cyst and bladder cuff (single-stage excision) was performed in the other five patients. These patients had a mean postoperative hospitalization time of 9.2 days (with a range of four to 15 days), and complications included an enterocutaneous fistula, which required additional operative treatment. The best method of treating an infected urachal cyst remains a matter of debate. However, based on our results, the two-stage procedure is associated with a shorter hospital stay and no complications. Thus, when infection is extensive and severe, we suggest that the two-stage procedure offers a more effective treatment option.
Collapse
Affiliation(s)
- Koo Han Yoo
- Department of Urology, School of Medicine, Kyunghee University, Seoul, Korea
| | - Sun-Ju Lee
- Department of Urology, School of Medicine, Kyunghee University, Seoul, Korea
| | - Sung-Goo Chang
- Department of Urology, School of Medicine, Kyunghee University, Seoul, Korea
| |
Collapse
|
71
|
Abstract
We report a term male neonate who was born with a large, red, tubular, mucosa-lined umbilical mass containing a patent lumen. Prenatal ultrasonographic screening at 20 to 28 weeks of gestation revealed a large cyst at the umbilicus, communicating with the urinary bladder. The cyst resolved at 32 weeks, and a small solid mass was newly seen on the fetal abdominal wall, inferior to the umbilical cord insertion. At operation, the mass was discovered to be the prolapsed, open, everted dome of the urinary bladder. The dome was resected, and the bladder was repaired in 2 layers after identification of the ureteral orifices. Bladder prolapse through a patent urachus can be predicted by prenatal ultrasound and has a distinct neonatal appearance.
Collapse
Affiliation(s)
- Brian Lugo
- Division of Pediatric Surgery, University of California, Irvine School of Medicine, Orange, CA 92868-3298, USA
| | | | | |
Collapse
|
72
|
Agbreta N, Boutens A, Debodinance P. [Dermoid cyst of the urachus: a case report and review of the literature]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2006; 35:75-8. [PMID: 16446615 DOI: 10.1016/s0368-2315(06)76375-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The urachus, a normal embryonic remnant of the primitive bladder dome, exists as a fibrous cord in adult. Urachal disorders are not exceptional, and are expression of incomplete regression. Diagnosis is generally ultrasonographic, rarely clinical. We report a case of urachal dermoid cyst revealed by abdominal pain and underline the diagnostic difficulties related to this unusual localization.
Collapse
Affiliation(s)
- N Agbreta
- Service de Gynécologie Obstétrique, CH de Dunkerque, Saint-Pol-sur-Mer
| | | | | |
Collapse
|
73
|
Jung BJ, Seo JM, Lee SK, Park KH. Urachal Anomalies in Children: A Proper Approach and Treatment Based on the Recent Ten-year Experience. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.6.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Byung Joo Jung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Hyun Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
74
|
Gimeno Argente V, Domínguez Hinarejos C, Serrano Durbá A, Estornell Moragues F, Martínez Verduch M, García Ibarra F. Quiste de uraco infectado en edad infantil. Actas Urol Esp 2006; 30:1034-7. [PMID: 17253073 DOI: 10.1016/s0210-4806(06)73581-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- V Gimeno Argente
- Servicio de Urología Infantil, Hospital Universitario La Fe, Valencia.
| | | | | | | | | | | |
Collapse
|
75
|
Little DC, Shah SR, St Peter SD, Calkins CM, Murphy JP, Gatti JM, Gittes GK, Sharp RJ, Andrews WS, Holcomb GW, Ostlie DJ, Snyder CL. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg 2005; 40:1874-6. [PMID: 16338309 DOI: 10.1016/j.jpedsurg.2005.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Children with a wet, draining, or infected umbilicus are often referred to pediatric surgeons. Unfortunately, uniform guidelines regarding diagnostic imaging are lacking. Historically, the persistence of the urachus was attributed to intrauterine distal urinary obstruction. Today, many surgeons continue to advocate preoperative voiding cystourethrogram (VCUG). METHODS Records of children with urachal abnormalities over the past 10 years were reviewed. Demographics, presentation, imaging, genitourinary anomalies, operations, length of stay, and complications were recorded. Statistical evaluation was by descriptive analysis. RESULTS Fifty-six children were diagnosed with urachal anomalies. Age at operation was 2.5 years (1 day-13 years). Fifty percent of patients were less than 1 year. Ultrasound was used in 88% of cases. Voiding cystourethrogram (34%) and computed tomography (14%) were also used. Average hospitalization was 1.9 (0-13) days. Thirty-two percent underwent operations as outpatients. Seven percent developed wound infections. Eight children (14%) had genitourinary anomalies. However, no VCUG examination (n = 19) documented an obstructive process. CONCLUSIONS The current study represents the largest reported series of symptomatic urachal anomalies in children. Disorders of the urachus are variable in presentation with the diagnosis reliably made by history and ultrasound alone. Further testing, including VCUG, is not warranted, adding additional cost, an invasive procedure, and inconvenience to the child.
Collapse
Affiliation(s)
- Danny C Little
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|