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The role of laparoscopy in the management of urachal anomalies in children. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000513181.72166.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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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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[Study of laparoendoscopic single-site surgery (LESS) for urachal remnants in our department]. Nihon Hinyokika Gakkai Zasshi 2014; 104:697-701. [PMID: 24564076 DOI: 10.5980/jpnjurol.104.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined laparoendoscopic single-site surgery (LESS) for urachal remnants and evaluated its usefulness and efficacy. PATIENTS AND METHODS From August 2011 to July 2012, we underwent this surgery for 5 patients (3 males, 2 females). The mean age was 30.8 (25-36) years old. A 2 cm incision was made around the umbilicus and Access Platform was placed. The entire urachal tissues were excised, and this 2 cm incison was reshaped as the umbilicus. RESULTS The median operative time was 220 (156-460) minutes, and the median operative blood loss was 10 (10-70) ml. They had no operative complications, and were discharged 6 (5-14) days after surgery. CONCLUSIONS Our surgical procedures have very excellent cosmesis and advantages in particular for young because we reshape as the umbilicus the surgical wound. We think that this surgery can be performed safe and effectively for surgeons trained in the conventional laparoscopic procedures.
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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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Iida T, Kawa G, Takizawa N, Kawabata T, Komai Y, Kinoshita H, Matsuda T. Laparoendoscopic single-site surgery for urachal remnants. Asian J Endosc Surg 2012; 5:100-2. [PMID: 22776374 DOI: 10.1111/j.1758-5910.2011.00126.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Urachal remnants are relatively rare but may potentially cause various symptoms and an increased risk for developing adenocarcinoma. Open or laparoscopic surgery is usually used for their resection. Laparoendoscopic single-site surgery has been recently applied in several surgical procedures. This report describes two cases of vesicourachal diverticulum treated by resection using laparoendoscopic single-site surgery. MATERIALS AND SURGICAL TECHNIQUE In each case, laparoendoscopic single-site surgery was performed transperitoneally via one port at a subumbilical semicircular incision. Except for a flexible camera and SILS Port, traditional, non-flexible laparoscopic instruments were used. After the induction of general anesthesia, the patient was placed in a supine position (or lithotomy position). A 2.0-cm incision was made semicircumferentially following the natural subumbilical folds. After the umbilical ligament was cut under direct vision, a SILS Port was placed at the incision. The urachus was liberated distally down to the roof of the urinary bladder using 0° 5-mm flexible camera. Vesicourachal diverticulum with a bladder cuff was completely excised under the supporting view of cystoscopy. Both patients' perioperative days were uneventful. DISCUSSION Our findings suggest that the laparoendoscopic single-site surgery procedure is safe, minimally invasive and cosmetically acceptable. Therefore, this procedure is an excellent option for the radical resection of urachal remnants.
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Affiliation(s)
- T Iida
- The Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan.
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Lee HE, Jeong CW, Ku JH. Robot-assisted laparoscopic management of urachal cysts in adults. J Robot Surg 2010; 4:133-5. [PMID: 27628779 DOI: 10.1007/s11701-010-0190-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 04/26/2010] [Indexed: 11/28/2022]
Abstract
We report two cases where a urachal cyst was managed by robot-assisted laparoscopic surgery. A 47-year-old man and a 43-year-old woman presented with gross hematuria and lower abdominal pain, respectively. Diagnosis of urachal cyst was established by computed tomography imaging. Robot-assisted laparoscopic surgery was performed transperitoneally via four ports. Both patients were diagnosed as having a urachal cyst with inflammation. Our experience suggests that robot-assisted laparoscopic excisions of urachal cysts can be performed easily and safely in adults.
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Affiliation(s)
- Hahn-Ey Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul, 110-744, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul, 110-744, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul, 110-744, Korea.
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Ng DCK, Yau KKK, Li MKW. Laparoscopic excision of infected urachal cyst: Illustration of technique. SURGICAL PRACTICE 2010. [DOI: 10.1111/j.1744-1633.2010.00493.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Lee SI, Kim SS, Moon HY. Laparoscopic Extraperitoneal Resection of Urachal Cyst. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.4.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sun-Il Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | | | - Hong-Young Moon
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Chiarenza SF, Scarpa MG, D'Agostino S, Fabbro MA, Novek SJ, Musi L. Laparoscopic Excision of Urachal Cyst in Pediatric Age: Report of Three Cases and Review of the Literature. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S183-6. [PMID: 19021462 DOI: 10.1089/lap.2008.0184.supp] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Maria Grazia Scarpa
- Department of Pediatric Surgery, S. Bortolo Hospital Vicenza, Vicenza, Italy
| | - Sergio D'Agostino
- Department of Pediatric Surgery, S. Bortolo Hospital Vicenza, Vicenza, Italy
| | | | - Steven J. Novek
- Department of Pediatric Surgery, S. Bortolo Hospital Vicenza, Vicenza, Italy
| | - Luciano Musi
- Department of Pediatric Surgery, S. Bortolo Hospital Vicenza, Vicenza, Italy
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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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Chiarenza SF, Scarpa MG, D'Agostino S, Fabbro MA, Novek SJ, Musi L. Laparoscopic excision of urachal cyst in pediatric age: report of three cases and review of the literature. J Laparoendosc Adv Surg Tech A 2008. [PMID: 19021462 DOI: 10.1089/lap.2008.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the role of laparoscopic surgery in the treatment of pediatric urachal disorders. METHODS Case reports and a literature review of laparoscopic excision of urachal remnants. RESULTS In a five-year period, three children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms, and were treated by laparoscopic surgery. The average age was 8.3 years (range, 4-13),and there were two girls and one boy. Mean operative time was 90 minutes (range, 60-120), and there were nopostoperative complications. The three patients were all discharged by postoperative day four. CONCLUSION Laparoscopy is an effective and safe minimally invasive technique in the management of pediatricurachal anomalies. It is effective even in cases of infected urachal cysts.
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Stroup SP, Thoman DS. A Naval Surgeon's Approach to the Draining Umbilicus. J Laparoendosc Adv Surg Tech A 2007; 17:645-8. [PMID: 17907979 DOI: 10.1089/lap.2006.0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spontaneous umbilical drainage is an uncommon problem in the adult, for which various congenital or acquired conditions may be responsible. In this paper, we present 3 cases demonstrating an approach that avoids the need for expensive diagnostic imaging. A careful office exam and basic laparoscopic skills are all that is needed. A brief discussion and review of the literature follows.
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Affiliation(s)
- Sean P Stroup
- Department of Urology, Naval Medical Center San Diego, San Diego, CA 92134, USA.
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Abstract
OBJECTIVE To present our initial experience with laparoscopic partial cystectomy (LPC) in selected patients with various bladder pathologies. PATIENTS AND METHODS Between December 2004 and April 2006, four patients had LPC at our centre (mean age 52 years, range 35-70); the transperitoneal approach was used for three and a pre-peritoneal approach for one. The surgical procedures used sequentially included transurethral incision around the lesion, laparoscopic excision of the lesion (partial cystectomy) and intracorporeal suturing. Laparoscopic pelvic lymphadenectomy was also used for the two patients with malignancy. RESULTS All operations proceeded smoothly; the bladder pathologies included one bladder endometriosis, one bladder leiomyoma, one urothelial carcinoma within the bladder diverticulum and one urachal adenocarcinoma. The mean (range) operative duration was 197.5 (120-300) min, the estimated blood loss 70 (50-100) mL, the hospital stay 6.75 (5-9) days, and duration of Foley catheterization 7.25 (6-9) days. No open conversion was required and no patient had peri-operative complications. The surgical margins were free of cancer and the dissected lymph nodes were negative in those two patients with bladder malignancy. CONCLUSIONS LPC is safe and feasible in selected patients with various bladder pathologies.
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Affiliation(s)
- Huai-Ching Tai
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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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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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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Madeb R, Knopf JK, Nicholson C, Donahue LA, Adcock B, Dever D, Tan BJ, Valvo JR, Eichel L. The use of robotically assisted surgery for treating urachal anomalies. BJU Int 2006; 98:838-42. [PMID: 16978280 DOI: 10.1111/j.1464-410x.2006.06430.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the management of urachal anomalies using a robotically assisted approach. PATIENTS AND METHODS Between January 2005 and February 2006, five patients (mean age 51 years, range 24-68) were diagnosed with urachal anomalies. Two basic robot-assisted surgical approaches were used for excising the urachal anomalies: excision of the urachal remnant via partial cystectomy, and radical cystectomy for excision of urachal adenocarcinoma. RESULTS All five cases were successful and the excised specimens were assessed histologically. The short-term oncological outcome in the three patients with histologically confirmed moderately differentiated adenocarcinoma showed no evidence of recurrent disease within a median interval of 8 months. Surveillance follow-up cystoscopy in the patients who had a partial cystectomy showed a well-healed bladder mucosa with no evidence of recurrence. CONCLUSIONS Radical excision of the urachal tract with partial cystectomy or radical cystectomy using the da Vinci robot is safe, effective and technically feasible.
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Affiliation(s)
- Ralph Madeb
- Department of Urology, Rochester General Hospital, Rochester, New York, USA.
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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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Wadhwa P, Kolla SB, Hemal AK. Laparoscopic en bloc partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Urology 2006; 67:837-43. [PMID: 16618570 DOI: 10.1016/j.urology.2005.10.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 09/28/2005] [Accepted: 10/26/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical options for treating urachal adenocarcinoma include radical cystectomy and en bloc partial cystectomy with excision of the urachus and umbilectomy. Recently, laparoscopy has been increasingly used to treat bladder and urachal pathologic findings efficaciously. We describe two techniques for performing laparoscopic en bloc partial cystectomy with bilateral extended pelvic lymphadenectomy. TECHNICAL CONSIDERATIONS We performed the procedure in 3 patients with established urachal adenocarcinoma. The anatomic boundaries of resection were similar to those described for open surgery. We used an inverted V-shaped, five-port configuration, with the camera port placed 3 cm supraumbilically. An antegrade approach was performed for tumors less than 5 cm in 2 cases. The steps of the procedure included an inverted V-shaped incision along the peritoneum lateral to the medial umbilical ligament on either side; urachal disconnection, dissection of the urachus using the "twist and roll technique"; anterior cystotomy, circumferential resection of the tumor-bearing bladder dome, under vision; tumor placement in a "lap-bag"; bladder reconstruction using intracorporeal suturing; bilateral extended pelvic lymphadenectomy; placement of catheter and drain; and specimen retrieval. We evolved a retrograde technique for larger size tumors (larger than 5 cm). The procedure was successfully completed in all patients, with a mean operative time of 180 minutes (range 150 to 210). No significant intraoperative or postoperative complications occurred, except for a left inferior epigastric artery injury in 1 case. The resected nodes (range 8 to 11) were free of tumor. No local or distant recurrences were observed at a mean follow-up of 6.5 months (range 4.5 to 9). CONCLUSIONS Laparoscopic en bloc partial cystectomy and bilateral extended pelvic lymphadenectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for urachal tumors.
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Affiliation(s)
- Pankaj Wadhwa
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Milhoua PM, Knoll A, Bleustein CB, Ghavamian R. Laparoscopic partial cystectomy for treatment of adenocarcinoma of the urachus. Urology 2006; 67:423.e15-423.e17. [PMID: 16461107 DOI: 10.1016/j.urology.2005.08.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 07/15/2005] [Accepted: 08/17/2005] [Indexed: 11/26/2022]
Abstract
The treatment of choice for urachal carcinoma has traditionally been an open approach, either by radical cystectomy or the more recently adopted bladder-sparing approach of extended partial cystectomy and umbilectomy. We report for the first time a laparoscopic technique for an extended partial cystectomy with en bloc umbilectomy for the management of urachal carcinoma in a 41-year-old man.
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Affiliation(s)
- Paul M Milhoua
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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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.
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Affiliation(s)
- N Agbreta
- Service de Gynécologie Obstétrique, CH de Dunkerque, Saint-Pol-sur-Mer
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Abstract
OBJECTIVE To report our experience with a laparoscopic approach to managing symptomatic urachal anomalies. PATIENTS AND METHODS Five patients (median age 19 years, range 2-43) had a laparoscopic excision of a complicated urachal remnant between 2001 and 2004. Three ports were routinely used, although their positioning varied as our technique developed with experience. The urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact. RESULTS All five operations had no serious immediate complications and minimal blood loss. One patient developed a small peri-umbilical haematoma after surgery and another had a persistent umbilical discharge at follow-up, and required open excision of residual remnant tissue. CONCLUSIONS The laparoscopic approach appears to be a safe and effective alternative to open surgery for this condition. Despite the slight risk of incomplete excision, the reduced morbidity of this procedure and better cosmetic result would appear advantageous.
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Quicios Dorado C, Fernández Fernández E, Gómez García I, García Flórez D, De Castro Guerin C, Escudero Barrilero A. Retención aguda de orina, “RAO“, como presentación de quiste de uraco. Actas Urol Esp 2005; 29:909-12. [PMID: 16353780 DOI: 10.1016/s0210-4806(05)73365-9] [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: 11/17/2022]
Abstract
About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms.
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Allen JW, Song J, Velcek FT. Acute presentation of infected urachal cysts: case report and review of diagnosis and therapeutic interventions. Pediatr Emerg Care 2004; 20:108-111. [PMID: 14758308 DOI: 10.1097/01.pec.0000113880.10140.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urachal remnants, although relatively rare, masquerade as a large number of diverse disorders leading to a high rate of misdiagnosis. A typical case is reported in which a 10-year-old boy presented to the Emergency Department twice before being incorrectly diagnosed with a pelvic or lower abdominal periappendiceal abscess. Definitive diagnosis and treatment of an infected urachal cyst were made intraoperatively. A review and discussion of urachal remnants is presented, and a diagnostic algorithm and treatment plan is offered for this entity.
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Affiliation(s)
- Jason W Allen
- *Departments of Radiology and Neurology, New York University, New York, NY; †New York University School of Medicine, New York, NY; ‡Department of Surgery, Lenox Hill Hospital, New York, NY
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Yohannes P, Bruno T, Pathan M, Baltaro R. Laparoscopic radical excision of urachal sinus. J Endourol 2003; 17:475-9; discussion 479. [PMID: 14565877 DOI: 10.1089/089277903769013612] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persistent urachus is a rare congenital anomaly. Various types of remnants have been described including cyst, alternating sinus, patent urachus, diverticulum, and sinus. The most common presenting symptom of urachal sinus is umbilical discharge. Radical excision of the remnant, with or without a bladder cuff, is essential to prevent future malignant degeneration or recurrence of the remnant. Although open surgical excision has been the treatment of choice for many years, the laparoscopic approach has become an attractive alternative because of its association with less postoperative pain, better cosmesis, and rapid convalescence. Laparoscopic radical excision of a urachal sinus was performed in a 16-year-old female patient who presented with umbilical discharge.
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Affiliation(s)
- Paulos Yohannes
- Department of Surgery (Urology), Creighton University, Omaha, Nebraska 68131, USA.
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Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Armed Forces Hualien General Hospital, Hualien, Taiwan, R.O.C. China
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Abstract
BACKGROUND/PURPOSE The abdominal manifestations of urachal remnants often prompt referral to the pediatric general surgeon. The purpose of this study was to evaluate the authors' management of this anomaly. METHODS The authors performed a retrospective review of patients presenting to their institution with urachal remnants between 1984 and 2001. Clinical and radiographic details of presentation, management, and outcomes are described. RESULTS Twenty-six patients presented at a median age of 4 years (range, 2 days to 12 years), 16 were boys, and 18 required inpatient care. Eleven (42%) presented with infection, 7 (27%) with clear drainage, 3 (12%) with umbilical polyps/granulation, 3 (12%) with pain, one (4%) with recurrent urinary tract infections, and one (4%) with an asymptomatic punctum. One had an associated anomaly (hypospadias). Urinalysis and urine cultures did not correlate with infection. Ultrasound scan was diagnostic in greater than 90% of cases. Overall, 20 patients underwent primary cyst excision, and 6 underwent incision and drainage (I&D) with delayed excision. Five patients underwent primary excision while infected, and 2 had postoperative complications (wound infection and urine leak). All 6 patients who underwent 2-stage procedure initially presented with infection, and none had complications. CONCLUSIONS Persistent urachal remnants can present at any age with a variety of clinical manifestations. Ultrasound scan is a reliable diagnostic tool. Additional diagnostic studies generally are not warranted. Simple excision of noninfected lesions is appropriate. In cases of acute infection, initial I&D with delayed cyst excision may be preferable to avoid unnecessary complications.
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Affiliation(s)
- M O McCollum
- Division of Pediatric Surgery and Pediatric Urology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
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Yano H, Iwazawa T, Monden T. Excision of a urachal sinus with use of a voice-controlled laparoscope. J Laparoendosc Adv Surg Tech A 2003; 13:45-9. [PMID: 12676022 DOI: 10.1089/109264203321235476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 34-year-old man with an umbilical urachal sinus underwent a voice-controlled robot-assisted laparoscopic excision. In the operational procedure, three trocars were inserted into the peritoneal cavity. Exploration with a laparoscope revealed a cystic lesion at the middle part of the lower abdomen that extended about 4 cm in the major axis just from the umbilicus. The caudal stump of the urachus was ligated with an absorbable clip and divided. The cephalic side of the lesion was ligated just at the umbilicus with an Endo-Loop and divided. The lesion was then peeled from the peritoneum and taken from the peritoneal cavity. The robot allowed a safer and more secure movement of the scope. The postoperative course was uneventful, the surgical wound scars were very small, and the cosmetic results were satisfactory. There was no recurrence and no transformation of the navel. Our experience was encouraging enough to suggest that voice-controlled robot-assisted laparoscopic excision in patients with urachal disease is a beneficial therapeutic option that is easy, safe, and minimally invasive, with excellent cosmetic results.
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Affiliation(s)
- H Yano
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan.
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30
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Abstract
PURPOSE The laparoscopic approach to the complete excision of urachal abnormalities in adults has recently been advocated by some groups but little has been reported in the pediatric literature. We highlight the need for the complete removal of symptomatic urachal remnants as well as the feasibility of the laparoscopic approach in children. MATERIALS AND METHODS Four children 5 months, 4, 8 and 10 years old, respectively, who presented with complicated urachal disease underwent laparoscopic resection of urachal remnants. We describe the manner of presentation and surgical technique in these 4 cases. RESULTS Laparoscopic radical excision was successfully performed in all 4 cases with an uneventful convalescence. CONCLUSIONS Our experience suggests that laparoscopic excision of urachal remnants can be safely and satisfactorily performed in children of all ages.
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Affiliation(s)
- S Khurana
- University of Queensland and Department of Pediatric Surgery, Royal Children's Hospital, Brisbane, Australia
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32
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Yamada T, Okamoto Y, Kasamatsu H, Mori H. Laparoscopic-assisted removal of a large urachal cyst. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2001; 8:159-60. [PMID: 11172134 DOI: 10.1016/s1074-3804(05)60568-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 48-year-old woman was seen because of an abdominal tumor. Laparoscopy was performed for diagnosis and treatment. A large cystic mass was hanging from the anterior abdominal wall and was removed with laparoscopic assistance. Histologic examination revealed a urachal cyst. (J Am Assoc Gynecol Laparosc 8(1):159-160, 2001)
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Affiliation(s)
- T Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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34
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35
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Arai Y, Ogura K, Maekawa S, Okubo K, Okada T, Aoki Y. Laparoscopic excision of urachal cyst and segmental resection of bladder using harmonic scalpel. MINIM INVASIV THER 2000. [DOI: 10.3109/13645700009063043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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The Infected Urachal Cyst. J Urol 1997. [DOI: 10.1097/00005392-199705000-00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Minevich E, Wacksman J, Lewis AG, Bukowski TP, Sheldon CA. The infected urachal cyst: primary excision versus a staged approach. J Urol 1997; 157:1869-72. [PMID: 9112551 DOI: 10.1016/s0022-5347(01)64889-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We compared outcomes following single or 2-stage repair of infected urachal cysts in the pediatric population. MATERIALS AND METHODS We reviewed the records of 17 patients 1 day to 14 years old (median age 22 months) with a urachal cyst. Immediate cyst excision was performed in 6 patients without infection, while those with an abscess underwent single or 2-stage repair. RESULTS Median postoperative hospital stay for the urachal abscess group was 14 and 11.5 days for single and 2-stage procedures, respectively. After immediate excision postoperative complications developed in each case, although none occurred with a 2-stage approach. CONCLUSIONS In the absence of infection, urachal cyst excision affords the most benign postoperative course. However, when infection is present, perioperative drainage with subsequent total excision, including a cuff of bladder, may offer the most effective surgical option.
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Affiliation(s)
- E Minevich
- Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA
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Linos D, Mitropoulos F, Patoulis J, Psomas M, Parasyris V. Laparoscopic removal of urachal sinus. J Laparoendosc Adv Surg Tech A 1997; 7:135-8. [PMID: 9459815 DOI: 10.1089/lap.1997.7.135] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Disorders of urachal origin are rarely encountered in adults. Traditional treatment consists of a classic laparotomy and total excision of the urachal structure. We report a case of laparoscopic urachal sinus removal that was performed synchronously with laparoscopic cholecystectomy and ovarian cyst excision. We confirm that the laparoscopic technique can be effectively applied for the diagnosis and treatment of urachal anomalies.
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Affiliation(s)
- D Linos
- 3rd Surgical Clinic, Hygeia Hospital, Kifissia, Greece
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Abstract
OBJECTIVES To determine the role of laparoscopic surgery in the treatment of urachal disorders. METHODS A case report and literature review of laparoscopic urachal cyst procedures. RESULTS A 21-year-old man presented with a draining sinus at the umbilicus. A diagnosis of a urachal sinus was made. The patient underwent a laparoscopic excision of the sinus and cyst. CONCLUSIONS Minimally invasive techniques such as laparoscopic surgery are the preferred means of managing urologic diseases such as the urachal cyst.
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Affiliation(s)
- N N Stone
- Department of Urology, Mount Sinai School of Medicine, New York, New York
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