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Yuki H, Ohkubo N, Kurashina R, Sakamoto K, Suzuki I, Takei K, Betsunoh H, Nukui A, Yashi M, Kamai T. Transperitoneal laparoscopic umbilical resection of urachal remnants: a feasible surgical method. BMC Urol 2023; 23:57. [PMID: 37016347 PMCID: PMC10074811 DOI: 10.1186/s12894-023-01229-2] [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: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND To date, there is no standard established laparoscopic surgical method for managing urachal remnants because of their rarity, and several questions remain unanswered. Are there any problems for considering the operative indications about patients' factors for example, body mass index and so on? This study aimed to determine the feasible surgical method for managing urachal remnants and presents the operative outcomes of our cases in relation to the findings from the existing literature. METHODS We analyzed the data of 16 patients (7 women and 9 men; age range, 19-48 years) who underwent surgery for urachal remnants between January 2013 and March 2019 at our institution. RESULTS In our cases, all urachal remnants were urachal sinuses, and the primary complaints were umbilical pain and pus discharge. Most of these symptoms were controlled using umbilical drainage and oral antibiotic intake; however, incisional drainage was required in two cases. In all cases, we performed a laparoscopic resection of the urachal remnants; one patient underwent an open conversion due to a very thick abdominal wall. Therefore, "peri-umbilical distanse" was proposed as an index to verify the periumbilical abdominal wall thickness. This index may clear the difficulties of the laparoscopic resection of the urachal remnunts. A postoperative complication-local infection that was treated using re-suturing-was observed in one patient. No adverse events occurred in the other cases. Our method was appropriate because it allowed for complete urachal resection with good cosmetic results, i.e., a small and natural scar appearance. Additionally, if bladder injury occurred, bladder re-suturing was easily possible because of the laparoscopic port's position. CONCLUSIONS We present an feasible method for laparoscopic urachal resection. This method may be recommended for young patients with an peri-umbilical distanse of < 2 cm.
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Affiliation(s)
- Hideo Yuki
- Department of Urology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan.
| | - Naoya Ohkubo
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Ryo Kurashina
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Kazumasa Sakamoto
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Issei Suzuki
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Kohei Takei
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Hironori Betsunoh
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Akinori Nukui
- Department of Urology, Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Masahiro Yashi
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
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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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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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4
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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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5
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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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Ahmed H, Howe AS, Dyer LL, Fine RG, Gitlin JS, Schlussel RN, Zelkovic PF, Palmer LS. Robot-assisted Laparoscopic Urachal Excision in Children. Urology 2017; 106:103-106. [DOI: 10.1016/j.urology.2017.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/26/2022]
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7
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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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8
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Sato H, Furuta S, Tsuji S, Kawase H, Kitagawa H. The current strategy for urachal remnants. Pediatr Surg Int 2015; 31:581-7. [PMID: 25896294 DOI: 10.1007/s00383-015-3712-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR. MATERIALS AND METHODS A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome. RESULTS We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59%), a urachal cyst in 5 (18%) and a urachal duct in 6 (22%). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (n = 6, 54%). Group B was dominated by abdominal pain (n = 12, 75%). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA, n = 7) rather than the classical umbilical approach (UA, n = 13). The operation time was not significantly different (LA = 124 min: UA = 110 min, P > 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA. CONCLUSION Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.
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Affiliation(s)
- Hideaki Sato
- Department of Pediatric Surgery, St. Marianna University Yokohama City Seibu Hospital, 1197-1, Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan,
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Jeong HJ, Han DY, Kwon WA. Laparoscopic management of complicated urachal remnants. Chonnam Med J 2013; 49:43-7. [PMID: 23678477 PMCID: PMC3651986 DOI: 10.4068/cmj.2013.49.1.43] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/09/2013] [Accepted: 03/09/2013] [Indexed: 11/15/2022] Open
Abstract
Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.
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Affiliation(s)
- Hee Jong Jeong
- Department of Urology, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
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10
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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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11
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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.
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Affiliation(s)
- G C Gregory
- Department of General Surgery, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2EP, UK
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12
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Cruz-González G, Sánchez-Salas R, Sotelo R, Sánchez-Salas RE, Sánchez-Ismayel A, Sánchez R, Rodríguez O, Sanabria E. Manejo laparoscópico de las anomalías sintomáticas del uraco. Actas Urol Esp 2009. [DOI: 10.1016/s0210-4806(09)74142-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Kurtz M, Masiakos PT. Laparoscopic resection of a urachal remnant. J Pediatr Surg 2008; 43:1753-4. [PMID: 18779022 DOI: 10.1016/j.jpedsurg.2008.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/10/2008] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
Abstract
The surgical management of urachal remnants in children is evolving. This case is one example, with clear diagnostic imaging and excellent clinical results that were achieved laparoscopically.
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Affiliation(s)
- Michael Kurtz
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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14
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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.
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15
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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.
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Affiliation(s)
- B R Yapo
- Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, NSW, 2145, Australia
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16
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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.
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Affiliation(s)
- Jenny H Yiee
- Department of Urology, University of California Los Angeles, 650 Charles Young Drive, Los Angeles, CA 90095-1738, USA.
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17
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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.
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Affiliation(s)
- Salmai Turial
- Department of Pediatric Surgery, University Medical Center Mainz, Mainz, Germany.
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18
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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.
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Affiliation(s)
- Charles L Snyder
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
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Kojima Y, Hayashi Y, Yasui T, Itoh Y, Maruyama T, Kohri K. Laparoscopic management for urachal cyst in a 9-year-old boy. Int Urol Nephrol 2007; 39:771-4. [PMID: 17203350 DOI: 10.1007/s11255-006-9132-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 10/06/2006] [Indexed: 11/26/2022]
Abstract
We report a boy with urachal cyst managed laparoscopically. A 9-year-old boy was referred from another hospital with a history of low abdominal pain. We laparoscopically excised the urachal cyst, removing all structures within the umbilicovesical fascia, including the urachus and each medial umbilical ligament, as well as the associated peritoneum from the umbilicus to the bladder dome. Laparoscopic management of urachal disease can be performed safely, with minimal postoperative pain, excellent cosmetic results and early ambulation. We advocate the use of laparoscopic treatment of urachal anomalies in children.
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Affiliation(s)
- Yoshiyuki Kojima
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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20
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Abstract
BACKGROUND The aim of this study was to investigate the outcome of laparoscopic excision of urachal remnants (LUR), and to compare the outcome with that of the traditional open excision of urachal remnants (OUR). METHODS Between February 2001 and December 2005, six patients with a mean age of 23.8 years who had a symptomatic urachal sinus underwent radical LUR. Using 12 mm and 5 mm ports, the caudal stump of the urachus was ligated with an absorbable clip and divided. The peritoneal and preperitoneal tissue between the medial umbilical ligaments was dissected free of the transversalis fascia. Dissection was carried out along the preperitoneal plane toward the umbilicus. The cephalic side of the lesion was ligated at the umbilicus with an endo-loop and divided. In addition, four patients who underwent a traditional OUR were included. Peri- and postoperative records were reviewed to assess morbidity, recovery, and outcome. RESULTS The operative duration was not significantly shorter for the LUR group than the OUR group, but there was generally a reduction in blood loss (mean 16.5 vs 68.3 mL), an earlier resumption of eating (mean 1.3 vs 2.5 days), and a shorter hospital stay (mean 5.3 vs 10.5 days). There were no intraoperative complications in either the LUR or the OUR group. Mean follow up was 5 (range 4-12) months. There were no postoperative complications. CONCLUSIONS The results suggest that LUR can be safely and satisfactorily performed in adulthood.
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Affiliation(s)
- Takatsugu Okegawa
- Department of Urology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
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21
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Abstract
A few cases of laparoscopic surgery for urachal remnant in children has been reported in English literature. With recent developments in minimal invasive surgery, laparoscopic approach for urachal remnant in adulthood is recommended by some laparoscopic surgeons because of its technical feasibility and safety as well as cosmesis. Recently we experienced a case of complicated urachal remnant in a 14-month-old girl, who was managed by laparoscopic approach. At presentation, she complained of high fever and lower urinary tract symptoms. After 6 weeks of antibiotics therapy, laparoscopic surgery was performed transperitoneally via 3 ports. Our experience suggests that laparoscopic excision of urachal remnant can be performed easily and safely in children.
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Affiliation(s)
- Tong-Wook Kim
- Department of Urology, Konkuk University Chung-ju Hospital, Chungju, Korea
| | - Hong Chung
- Department of Urology, Konkuk University Chung-ju Hospital, Chungju, Korea
| | - Sang Kuk Yang
- Department of Urology, Konkuk University Chung-ju Hospital, Chungju, Korea
| | - Tae Ui Lee
- Department of Surgery, Konkuk University Chung-ju Hospital, Chungju, Korea
| | - Seung-Hyo Woo
- Department of Urology, Eulgi University College of Medicine, Deajeon, Korea
| | - Hong Sup Kim
- Department of Urology, Konkuk University Chung-ju Hospital, Chungju, Korea
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22
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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.
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Affiliation(s)
- Danny C Little
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
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23
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Esposito C, Valla JS, Yeung CK. Current indications for laparoscopy and retroperitoneoscopy in pediatric urology. Surg Endosc 2004; 18:1559-64. [PMID: 15931494 DOI: 10.1007/s00464-003-8272-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
Laparoscopy has raised great interest in the past few years in the field of pediatric urology. It has evolved from a simple diagnostic maneuver to complex operative procedures. The aim of this study was to review urologic laparoscopy literature and provide a critical review of this field to establish current indications for videosurgery in pediatric urology. In general, from an anatomic point of view, retroperitoneoscopy seems to be more suitable than the transperitoneal laparoscopic approach for reaching the upper urinary tract. It also is less invasive and complies with the criteria for open renal surgery. With respect to current indications for videosurgery in pediatric urology, the authors have identified several well-established clinical procedures, although no large series have been published for any of the procedures, except for the treatment of varicocele, nonpalpable testis, and nephrectomy. In conclusion, the data reviewed suggest that videosurgery is a safe and feasible technique in pediatric urology if performed by expert surgeons, and that it certainly will develop further in the next few years.
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Affiliation(s)
- C Esposito
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy.
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24
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Abstract
The evolution of laparoscopic surgery in pediatric urology has been long and slow, but is emerging steadily and seems to be here to stay. This article reviews the basic applications of laparoscopic methods in pediatric urology, including diagnostic and operative procedures. The new horizons of robotic assistance for laparoscopic surgery make highly accurate and efficient reconstructive procedures possible.
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Affiliation(s)
- Craig A Peters
- Department of Urology, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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