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Sghaier A, Lamloum E, Debaibi M, Sridi A, Chouchene A. Surgical management of benign noninfected urachal cysts in adult patients: two case reports. J Med Case Rep 2023; 17:214. [PMID: 37221572 DOI: 10.1186/s13256-023-03944-8] [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: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. CASE PRESENTATION Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. DISCUSSION Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. CONCLUSION Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.
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Affiliation(s)
- Asma Sghaier
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Eya Lamloum
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mehdi Debaibi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Azza Sridi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Adnene Chouchene
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Arena S, Rossanese M, Di Fabrizio D, Romeo C, Ficarra V, Impellizzeri P. Robot-assisted excision of urachal cyst: case report in a child. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and then remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder. An early laparoscopic procedure could trigger a quiescent urachal remnant to become symptomatic, causing a lesion or infection either during carbon oxide contamination or insufflation or a periumbilical or suprapubic port placement.
Case presentation
A 15-year-old girl complaining of supra-pubic abdominal pain. About 2 months previously, she had undergone laparoscopic appendectomy for acute appendicitis, and early postoperative period was uneventful. She underwent a robotic-assisted excision of a urachal cyst.
Conclusions
It has been suggested that early laparoscopic procedures could trigger previously asymptomatic urachal remnants to become symptomatic. Robot-assisted excision of a urachal cyst is a safe, effective alternative to open surgery in children.
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Li S, Meng X, Liang P, Feng C, Shen Y, Hu D, Li Z. Clinical and Radiological Features of Urachal Carcinoma and Infection. Front Oncol 2021; 11:702116. [PMID: 34557408 PMCID: PMC8454411 DOI: 10.3389/fonc.2021.702116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/19/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To explore the clinical and radiological differences between urachal carcinoma and urachal infection. METHODS Clinical and imaging information for 13 cases of urachal carcinoma and 14 cases of urachal infection confirmed by pathology were retrospectively analyzed. The size, location, shape, margin, lesion composition, calcification, T1 and T2 signal intensity, peripheral lymph nodes, degree of enhancement, adjacent bladder wall, and apparent diffusion coefficient (ADC) value were examined in both groups, and distinguish features were determined. The student t-test or Mann-Whitney U test was used for quantitative data, and Fisher's exact test was used for qualitative data. Kappa coefficient consistency test was used to evaluate the interobserver agreement. RESULTS Sex, hematuria, abdominal pain, calcification, and thickening of adjacent bladder wall can distinguish between urachal carcinoma and urachal infection (p < 0.05). There were no statistical differences in age (p = 0.076), size (p = 0.797), location (p = 0.440), shape (p = 0.449), margin (p = 0.449), lesion composition (p = 0.459), T1 signal intensity (p = 0.196), T2 signal intensity (p = 0.555), peripheral lymph nodes (p = 0.236), degree of enhancements (p = 0.184) and ADC value (p = 0.780) between two groups. CONCLUSION The following clinical and imaging features help distinguish urachal carcinoma from urachal infection: sex, hematuria, abdominal pain, calcification, and thickening of the adjacent bladder wall.
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Affiliation(s)
| | | | | | | | | | | | - Zhen Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Osumah TS, Granberg CF, Butaney M, Gearman DJ, Ahmed M, Gargollo PC. Robot-Assisted Laparoscopic Urachal Excision Using Hidden Incision Endoscopic Surgery Technique in Pediatric Patients. J Endourol 2020; 35:937-943. [PMID: 32013581 DOI: 10.1089/end.2019.0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Although laparoscopic urachal excision in children has been well reported, there are limited data on a robot-assisted surgery (RAS) approach. The hidden incision endoscopic surgery (HIdES) technique is an established method of eliminating visible scars following a number of RAS urologic procedures. We report our experience of using a robotic approach to treat urachal anomalies in children, and we present the first description of utilizing the HIdES port configuration for this procedure. Materials and Methods: We retrospectively reviewed pediatric patients who underwent resection of a urachal remnant at our institution from 2013 to 2018. Surgical techniques were either the traditional open approach (OA) or RAS. HIdES trocar placement configuration was employed in all robotic cases. Patient demographics, perioperative data, pathology reports, and outcomes were abstracted and compared. Results: Twenty-three patients underwent a urachal remnant resection in the study period (RAS: 14 patients vs OA: 9 patients). RAS patients were older (8.5 vs 2.0 years, p = 0.031) and weighed more than OA patients (36.1 vs 13.9 kg, p = 0.063). Median operative time for RAS was longer than OA operative time (136 vs 33 minutes, p < 0.01). Fewer RAS patients were outpatient compared with OA (7.1% vs 66.7%, p < 0.01), but with a median length of stay of 1 day (0-1 day). Two patients (14.3%) in the RAS group experienced postoperative complications within 1 week of the procedure compared with 1 (11.1%) in the OA group. There was no significant difference in blood loss, postoperative narcotic requirements, or duration of follow-up between both groups. Conclusion: RAS is a safe and feasible alternative to open surgery for urachal anomalies. Complete excision can be achieved by using HIdES port configuration, allowing for excellent cosmetic outcomes that are superior to traditional surgical scars without limitation to essential surgical ergonomics.
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Affiliation(s)
| | | | - Mohit Butaney
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Ahmed
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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5
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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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Liu Z, Yu X, Hu J, Li F, Wang S. Umbilicus-sparing laparoscopic versus open approach for treating symptomatic urachal remnants in adults. Medicine (Baltimore) 2018; 97:e11043. [PMID: 29952943 PMCID: PMC6039640 DOI: 10.1097/md.0000000000011043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The traditional surgical approach for removing a symptomatic urachal remnant is via a lower midline laparotomy and infraumbilical incision or a laparoscopic approach with umbilicoplasty. We reviewed our experience with umbilicus-sparing laparoscopic urachal remnant excision in a single-center study and evaluated its efficacy versus open approach (OA). This study was a retrospective study. Between March 2012 and September 2016, 32 consecutive patients with symptomatic urachal remnants underwent the umbilicus-sparing laparoscopic approach (USLA) (n = 17) or OA (n = 15). The efficacy, recovery, and long-term outcomes were reviewed. Our Results showed that the clinical characteristics of the patients in each group, such as age, gender, body mass index (BMI), and disease type, had no significant differences (P > .05). No significant difference was found in the surgical procedure times (76.1 ± 15.4 vs 69.2 ± 13.9 minutes, P = .189) and intraoperative blood loss (29.4 ± 13.3 vs 32.2 ± 12.9 mL, P = .543) between the USLA groups and OA groups. However, the mean postoperative hospital stay (patients with bladder cuff excision: 4.1 ± 1.8 vs 6.1 ± 1.4 days, P = .040 and patients without bladder cuff excision: 1.8 ± 0.5 vs 3.6 ± 0.8 days, P < .001) and the time of full recovery (11.2 ± 1.9 vs 15.6 ± 3.1 days, P < .001), the USLA group were both significantly shorter than that of the OA group. No infected recurrence and malignant transformation had occurred at a mean follow-up of 32.4 ± 8.1 and 34.1 ± 8.8 months in USLA group and OA group, respectively. In conclusion, to minimize the morbidity of radical excision, umbilicus-sparing management of benign urachal remnants in adults is a safe and efficacious alternative with superior cosmetic outcomes, postoperative recovery compared with an OA or umbilicoplasty.
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Chen A, Chong J, Si Q, Haines K, Mehrazin R. Robotic approach to resection of villous adenoma of the urachus: a case report and literature review. J Robot Surg 2017; 12:567-570. [PMID: 28889213 DOI: 10.1007/s11701-017-0753-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Very few cases of villous adenomas of the bladder or urinary tract have been described. To our knowledge this is the first account of resection of an urachal villous adenoma via robotic laparoscopy, which is a safe and efficacious surgical approach. At this time, there is not enough evidence to suggest that progression of disease to carcinoma is the typical course. Nonetheless, follow-up cystoscopy is recommended after complete removal of the adenoma to monitor for recurrence. This case report reviews the current literature and describes a novel approach to treatment of this exceedingly rare entity.
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Affiliation(s)
- Annie Chen
- Department of Urology, Albany Medical College, 23 Hackett Blvd, Albany, NY, 12208, USA.
| | - Julio Chong
- Department of Urology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1272, New York, NY, 10029, USA
| | - Quisheng Si
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1194, New York, NY, 10029, USA
| | - Kenneth Haines
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Reza Mehrazin
- Department of Urology, The Icahn School of Medicine at Mount Sinai, 5 East 98th St., 6th Floor, New York, NY, 10029-6574, USA
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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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Kilday PS, Finley DS. Robot-Assisted Excision of a Urachal Cyst Causing Dyspareunia and Dysorgasmia: Report of a Case. J Endourol Case Rep 2016; 2:3-5. [PMID: 27579400 PMCID: PMC4996573 DOI: 10.1089/cren.2015.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Urachal remnants are a group of rare anatomical anomalies that include cysts, diverticula, and tumors. We present a case of a young female patient with dyspareunia and dysorgasmia related to a urachal cyst. Case: A patient with unique presentation of urachal cyst treated robotically. Patient had complete resolution of symptoms postoperatively. Conclusion: Robot-assisted excision of the urachal remnant provided durable symptom relief.
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Affiliation(s)
- Patrick S. Kilday
- Department of Urology, Kaiser Permanente Los Angeles, Los Angeles, California
| | - David S. Finley
- Department of Urology, Kaiser Permanente Los Angeles, Los Angeles, California
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Fode M, Pedersen GL, Azawi N. Symptomatic urachal remnants: Case series with results of a robot-assisted laparoscopic approach with primary umbilicoplasty. Scand J Urol 2016; 50:463-467. [PMID: 27575694 DOI: 10.1080/21681805.2016.1221852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mikkel Fode
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | | | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
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Wang B, Li X, Ming S, Ma X, Li H, Ai Q, Zhang X. Combined Extraperitoneal and Transperitoneal Laparoscopic Extended Partial Cystectomy for the Treatment of Urachal Carcinoma. J Endourol 2016; 30:280-5. [PMID: 26531333 DOI: 10.1089/end.2015.0423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Baojun Wang
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xintao Li
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shaoxiong Ming
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xin Ma
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qing Ai
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
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Rivera M, Granberg CF, Tollefson MK. Robotic-Assisted Laparoscopic Surgery of Urachal Anomalies: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2015; 25:291-4. [DOI: 10.1089/lap.2014.0551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Kosanovic R, Romero RJ, Arad JK, Gallas M, Seetharamaiah R, Gonzalez AM. Rare use of robotic surgery for removal of large urachal carcinoma. J Robot Surg 2014; 8:177-80. [PMID: 27637529 DOI: 10.1007/s11701-013-0415-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
Minimally invasive surgery has been used traditionally for removal of colorectal, gastric and gallbladder disease pathologies with great success. Many advantages have been demonstrated with the addition of robotic surgery, such as 3-D visualization, articulation of instruments and improved surgeon ergonomics while operating. These benefits have allowed the implementation of robotic surgery into new areas. We describe here a rare case of a robotic resection of an urachal carcinoma. A 53-year-old female patient presented to her primary care physician (PCP) with a chief complaint of recurrent urinary tract infections. An initial urinary bladder ultrasound showed a large mass anterior and superior to the bladder, thus prompting an abdominal/pelvic MRI, which confirmed a large complex cystic mass anterior to and abutting the urinary bladder (5.4 × 6.7 × 5.9 cm). A follow-up cystoscopy showed no abnormal findings within the bladder. Based on the patient's symptoms and imaging, a careful evaluation by her PCP, oncology and surgical team prompted for the removal of the mass. Because of the uncertainty, complexity and location of the mass the patient was offered surgical treatment with the da Vinci robot. Histopathology revealed an urachal adenocarcinoma, well differentiated. We present that surgical resection of an urachal tumor can be performed with the da Vinci robot. Robotic surgery can add to the benefits seen with the conventional laparoscopic approach and thus can be an accepted method for treatment of abdominal wall masses.
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Affiliation(s)
| | - Rey J Romero
- Department of Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Jonathan K Arad
- Department of Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Michelle Gallas
- Department of Surgery, Baptist Health South Florida, Miami, FL, USA
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15
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Improved laparoscopic treatment of symptomatic urachal anomalies. World J Urol 2013; 31:1475-81. [PMID: 23408208 DOI: 10.1007/s00345-013-1039-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Remaining urachal anomalies are seldom found but can result in long-standing recurrent symptoms and repeated surgery. In this single-centre study, we evaluated the laparoscopic approach of excision of the urachus leaving the umbilicus untouched. METHODS Twenty-one patients were operated on for persisting symptomatic urachal anomalies between 1998 and 2011. Patients included 8 males and 13 females (mean 28.5 years, range 15-72 years). Patients' histories, surgical data and demographic data were prospectively collected and analysed. During follow-up, patients were evaluated using the total body image and cosmesis questionnaire (BIQ). RESULTS Excision of the urachus was carried out in 18 cases in a laparoscopic three-trocar technique and in 3 cases using single-site surgery. In all cases, the infected umbilicus was left untouched. Mean surgical time of all procedures was 55.7 min (31-106 min). Histopathology confirmed an urachal anomaly in all cases. The former discharging or infected umbilicus healed without any complications. Sixteen patients could be included for the BIQ. Total body image score after surgery was 5.49 with a score of 5.0 being the most satisfactory result possible. The total cosmetic score was 21.37 close to the maximum score of 24. CONCLUSIONS The laparoscopic treatment of urachal anomalies using a three-trocar technique or the single-site surgery technique is both safe and effective. In our opinion, the excision of the umbilicus should be avoided. It simplifies the procedure and leads to satisfactory cosmetic results.
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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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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.
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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
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Black PC, Brown GA, Dinney CPN. Clinical and therapeutic significance of aberrant differentiation patterns in bladder cancer. Expert Rev Anticancer Ther 2007; 7:1015-26. [PMID: 17627461 DOI: 10.1586/14737140.7.7.1015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pure urothelial carcinoma makes up 90-95% of all bladder cancer. The remaining 5-10% represent urothelial carcinoma with aberrant differentiation patterns and nonurothelial carcinoma. Reviews on this topic often focus on the pathological features of these histologic subtypes. In this review we have summarized the clinical significance of each major histologic pattern and analyzed the response of each to standard treatment modalities. The main limitation to optimizing management is the inability to perform clinical trials owing to the rarity of these tumors. This can be circumvented to some degree by extrapolating knowledge acquired from more common similar tumors in other organ sites. Ultimately, however, multicenter clinical trials will need to be organized to address some key management issues.
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Affiliation(s)
- Peter C Black
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
The urachal ligament is an embryologic remnant connecting the dome of the bladder to the umbilicus via the ligamentum commune. Autopsy series suggest that in approximately a third of subjects, the urachal remnant may persist with tubular or cystic structures. However, tumors of this site are extremely rare. Patients usually present with hematuria and upon imaging, have evidence of a cystic or solid structure in the bladder dome or in the bladder midline. If a biopsy confirms adenocarcinoma, these tumors should be considered an urachal cancer until proven otherwise. Although there are no prospective clinical trials reported to date, large single-institution reports suggest surgical resection with a partial cystectomy and en bloc resection of the urachal ligament with umbilicus as the treatment of choice in the setting of localized disease. Although there is currently no definitive role for neoadjuvant or adjuvant chemotherapy in this tumor, risk factors predicting progression may allow for the selection of patients at higher relapse risk for prospective studies. Unfortunately, there are many patients who present with metastatic disease that currently is not likely to be curable. There is no standard chemotherapy regimen for these patients; however, there is new-found hope with a currently accruing clinical trial exploring a 5-fluorouracil-based chemotherapy combination in this patient population.
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Affiliation(s)
- Arlene Siefker-Radtke
- The University of Texas MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, 1155 Herman Pressler--Unit 1374, Houston, TX 77030-3721, USA.
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