Management of urachal anomalies in children: insights from a retrospective cohort study
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Published on: November 30, 2010
Suhaib Abdulfattah1, Iqra Nadeem1, Yashaswi Parikh1
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
In pediatric urachal anomalies (UA), infection and urachal cysts are the main reasons for surgery, not malignancy. This study highlights infection as the primary driver for surgical intervention in children with UA.
Area of Science:
- Pediatric Urology
- Surgical Pathology
- Medical Imaging
Background:
- Urachal anomalies (UA) are rare congenital conditions, with surgical excision typically reserved for large or symptomatic cases.
- Urachal malignancy is exceedingly rare in pediatric patients, making prophylactic surgery generally unwarranted.
- Infection is hypothesized as a primary driver for surgical intervention in pediatric urachal anomalies.
Purpose of the Study:
- To investigate the predominant indications for surgical intervention in pediatric urachal anomalies.
- To identify clinical and imaging factors associated with surgical excision of urachal anomalies in children.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) diagnosed with urachal anomalies (UA) via ultrasound (US) from July 2012 to December 2021.
- Inclusion criteria included confirmed UA on US; exclusion criteria involved clinical mimics, prior excision by other services, or concomitant procedures.
- Data analysis included univariate and multivariable analyses to identify factors predicting surgical intervention.
Main Results:
- Of 78 pediatric patients with UA, 35 (44.9%) underwent surgical excision.
- Infectious presentation and a 'urachal cyst' classification on US were significantly associated with surgical intervention (p=0.046 and p=0.008, respectively).
- Excision was predominantly performed laparoscopically (80.0%) or robotically (11.4%), with no cases suspicious for malignancy.
Conclusions:
- Infectious symptoms and urachal cyst classification on ultrasound are key factors prompting surgical excision in pediatric urachal anomalies.
- This study supports the hypothesis that infection is a major etiology leading to surgical intervention in this population.
- Surgical management in this cohort focused on symptomatic or infected urachal anomalies, avoiding prophylactic excision due to the rarity of malignancy.
Introduction:
While large and symptomatic urachal anomalies (UAs) often lead to surgical excision, urachal malignancy is rare, rendering prophylactic excision unwarranted. We hypothesize that in the pediatric population, the presentation of an infected UA is the predominant etiology leading to surgical intervention.
Methods:
We retrospectively identified patients with UA from July 2012 to December 2021 evaluated in our urology outpatient. Inclusion criteria included patients ≤18 years old and confirmation of UA on ultrasound (US). Exclusion criteria were patients diagnosed with clinical mimickers on US, excision by general pediatric surgery service, or excision done concomitantly as part of another urological procedure.
Results:
We identified a total of 78 patients with UA. Of those, 35 (44.9%) underwent excision. The observation cohort was younger (5 months vs. 73 months, p=0.002), more likely to be asymptomatic (65.1% vs. 85.7%, p=0.038), and more likely to have UA characterized as a 'remnant' on US (72.1% vs. 48.6%, p=0.034). Univariate analysis showed that infected or symptomatic UA, or those characterized as hyperemic, cystic, or as a diverticulum on US were more likely to be excised. Multivariable analysis shows that patients with a 'urachal cyst' classification (p=0.008) and infectious presentation (p=0.046) were more likely to undergo surgical intervention. Excision was accomplished laparoscopically (80.0%) or robotically (11.4%). No excised UA was suspicious for malignancy.
Conclusion:
We present a large pediatric cohort with UA and found that infectious symptoms at presentation and those classified as 'urachal cyst' based on US were more likely to prompt surgical excision as compared with other factors.
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