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Published on: November 1, 2018
Conservative management of urachal anomalies
Christopher R Dethlefs1, Shahab F Abdessalam1, Stephen C Raynor1
1Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE.
Purpose:
The purpose of this study was to evaluate trends in management of urachal anomalies at our institution and the safety of nonoperative care.
Methods:
Based on our experience managing urachal remnants from 2000 to 2010 (reported in 2012), we adopted a more conservative approach, including preoperative antibiotic use, refraining from using voiding cystourethrograms (VCUG), postponing surgery until at least six months of age, and considering nonoperative management. A retrospective analysis of urachal anomaly cases was conducted (2011-2016) to assess trends in practice. Charts indicating anomalies of the urachus were pulled and trends in management (nonoperative versus surgical treatment), VCUG and antibiotic use, and outcomes were reviewed.
Results:
Data from 2000-2010 and 2013-2016 were compared. Our findings indicate care has shifted towards nonoperative management. A smaller proportion of patients from 2013-2016 was treated surgically compared to 2000-2010. Patients receiving nonoperative treatment exhibited lower rates of complication relative to surgically managed cases. VCUGs were eliminated as a diagnostic tool for evaluating urachal anomalies. Prophylactic preoperative antibiotic use was standardized. No patients with a known urachal remnant presented later with an abscess or sepsis.
Conclusions:
We find that a shift towards nonoperative treatment of urachal anomalies did not adversely affect overall outcomes. We recommend observing minimally symptomatic patients, especially those under six months old.
Study Type:
Performance improvement.
Level Of Evidence:
Level IV.
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