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Investigation and management of suspected urachal anomalies in children
B R Yapo1, B Gerges, A J A Holland
1Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, NSW, 2145, Australia.
Insights
Urachal anomalies are rare but can cause serious issues if diagnosis is delayed. Surgical removal is effective and safe for treating these conditions in children.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Urachal anomalies are uncommon congenital conditions.
- Delayed diagnosis of urachal anomalies can lead to significant morbidity.
Purpose of the Study:
- To review the institution's experience in diagnosing and managing urachal anomalies in children.
- To evaluate the effectiveness of diagnostic tools and surgical outcomes.
Main Methods:
- Retrospective review of 25 children with suspected urachal anomalies from November 1995 to June 2006.
- Analysis of clinical presentations, diagnostic methods (ultrasound, micturating cystourethrogram), and surgical outcomes.
Main Results:
- The mean age of presentation was 12 months, with 14 males.
- Common presentations included granulomatous polyp (16 cases), umbilical discharge (4 cases), and umbilical sepsis (2 cases).
- Ultrasound was the primary imaging tool; 36% of correct diagnoses required further imaging or surgery. Patent urachus was confirmed in 12 children.
Conclusions:
- Clinical examination is crucial, but radiological imaging and surgical exploration are often necessary for accurate diagnosis of urachal anomalies.
- Surgical excision is an effective treatment with no reported morbidity or mortality in this cohort.
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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