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Advances in the management of infected urachal cysts
Insights
Persistent urachal remnants, often presenting as infected cysts, can be safely treated with antibiotics and prompt surgical excision. This approach is effective and reduces complications, especially when associated genitourinary abnormalities are present.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Urology
Background:
- Persistent urachal remnants are rare congenital anomalies.
- Infection is often the first sign of urachal remnants, especially without a fistula.
- Urachal cyst infections can present as lower abdominal masses with fever and tenderness.
Purpose of the Study:
- To evaluate the management and outcomes of children with infected urachal remnants.
- To assess the efficacy of modern treatment protocols including antibiotics and early surgical excision.
- To highlight the importance of investigating associated genitourinary abnormalities.
Main Methods:
- Retrospective review of six pediatric cases treated between 1964 and 1984.
- Analysis of presenting signs, diagnostic studies (ultrasound), treatment modalities, and microbial cultures.
- Evaluation of associated genitourinary anomalies.
Main Results:
- Ultrasound was the most accurate diagnostic tool.
- Four of five patients cultured positive for Staphylococcus aureus or Escherichia coli.
- Four of five evaluated patients had significant genitourinary abnormalities.
- Antibiotic therapy followed by complete excision as a primary procedure was successful in five patients.
Conclusions:
- Modern management of infected urachal remnants favors prompt antibiotic therapy and complete surgical excision.
- This approach is safe and effective, superseding older methods of incision and drainage followed by delayed resection.
- Routine investigation for genitourinary anomalies is crucial in patients with urachal remnants.
Abstract:
Persistent urachal remnants are uncommon congenital anomalies. Unless an umbilical fistula exists, infection may be the first indication of this abnormality. Five children received initial treatment for this problem at the Children's Hospital of Buffalo during a 20-year period, 1964 to 1984, and a sixth was seen secondarily. There were four boys and two girls; their ages ranged from 8 months to 9 years. Lower abdominal mass with fever and local tenderness were the most common presenting signs. Ultrasound was the most accurate study, correctly diagnosing the cyst in both patients so examined. Incision and drainage alone was performed in one patient. The other five were managed with antibiotic therapy and complete excision as the primary procedure. Cultures were obtained in five patients and were positive in four, growing Staphylococcus aureus in three and Escherichia coli in one. Significant genitourinary abnormalities were discovered in four of the five patients evaluated. It is concluded that the previously recommended therapy of incision and drainage followed by delayed resection was developed in the preantibiotic era to minimize the mortality from sepsis and the morbidity from recurrence. Our experience indicates that the use of appropriate antibiotics followed promptly by complete cyst excision as a primary procedure is both possible and safe in most cases. Furthermore, the large number of associated genitourinary abnormalities suggests that a complete work-up for these conditions should be performed.