Conservative Management Versus Complete Excision for Pediatric Urachal Remnants: A Retrospective Comparative Study

The management of urachal remnants (URs) remains controversial. We compared conservative therapy with complete surgical excision to provide reference evidence for treatment decision-making and management strategies for URs.

We retrospectively reviewed cases of URs treated at Shanghai Children's Hospital between June 2014 and June 2025. A total of 89 patients were ultimately included. Demographic and clinical data were collected and analyzed in the conservative management group (CM) and complete excision group (CE).

Of the 89 patients, 52 were included in the CM group and 37 in the CE group. Children in the CE group were significantly younger than those in the CM group(median age 0.2 years [IQR 0.1-0.8] vs 2.30 years [IQR 0.5-7.0]; P=0.001) and were predominantly younger than 1 year of age (P=0.001). Umbilical discharge was the most common presenting symptom in both groups. Urachal cysts were the predominant subtype in the CM group, whereas patent urachus was more common in the CE group. After initial discharge, 16 patients in the CM group were readmitted, 13 required secondary intervention, and 10 ultimately underwent complete surgical excision. One patient developed a postoperative bladder diverticulum. In the CE group, no patients were readmitted, two developed postoperative wound complications, and no anesthesia-related adverse events were observed. The CM group had a longer overall hospitalization duration (P=0.015), whereas the CE group incurred higher hospitalization costs (P=0.019).

Conservative treatment may be associated with a longer overall treatment course. Complete excision may offer the advantage of resolution in a single course of treatment, albeit at greater financial cost. For recurrent or emergent URs, however, prompt surgery should be strongly considered.