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Management of urachal anomalies in children and adults
1Pediatric Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel.
Insights
Urachal anomalies, including cysts and sinuses, affect both children and adults. Complete surgical excision of the umbilicovesical tract is the preferred treatment, with investigations for genitourinary anomalies recommended for children.
Area of Science:
- Urology
- Pediatric Surgery
- Surgical Oncology
Background:
- Urachal anomalies are congenital malformations of the urachus, a remnant of the allantois.
- These anomalies can lead to various complications, including infection, cyst formation, and sinus development.
- They present differently in pediatric and adult populations.
Purpose of the Study:
- To review the treatment outcomes of various urachal anomalies over a 15-year period.
- To compare the presentation and management of urachal anomalies in children versus adults.
- To highlight diagnostic and surgical considerations for urachal remnants.
Main Methods:
- Retrospective analysis of 14 patients (9 children, 5 adults) treated for urachal anomalies over 15 years.
- Clinical examination and ultrasound were primary diagnostic tools.
- Surgical management involved complete excision of the umbilicovesical tract, with staged procedures for critically ill patients.
- Methylene blue injection was used to identify communicating tracts.
Main Results:
- Infected urachal cysts were more prevalent in children, while infected urachal sinuses were more common in adults.
- Preoperative diagnosis was achievable in most cases via physical examination and ultrasound.
- Complete excision was feasible in most patients; staged treatment was necessary for severely ill individuals.
- Methylene blue aided in identifying and removing all communicating tracts.
Conclusions:
- Urachal anomalies require tailored management based on age and presentation.
- Complete surgical excision of the urachal remnant is crucial for successful treatment.
- Children with urachal anomalies necessitate screening for associated genitourinary anomalies.
Abstract:
During a period of fifteen years, 9 children and 5 adults with a variety of urachal anomalies were treated. Infected urachal cysts were more common in children whereas adults more frequently had infected urachal sinuses. After careful physical examination, a preoperative diagnosis could be made in most patients, with ultrasound examination decisive in doubtful cases. Whenever feasible, complete excision of the umbilicovesical tract is performed, but in very ill patients, a staged treatment becomes necessary. The preoperative injection of methylene blue is helpful in the identification of communicating tracts, all of which should be removed. All affected children should undergo investigation for associated genitourinary anomalies.