Urachal mass in adults: clinical analysis of 33 cases

Abstract

To summarize the experience in diagnosis and treatment of urachal mass in adults. The clinical data of 33 patients with urachal mass, 21 male and 12 females, aged 49 (30-75), were analyzed retrospectively. The urachal masses of 11 patients (33%, 11/33) were benign, including 5 cases of abscess, 3 of cyst, 2 of malacoplakia, and 1 of xanthogranuloma. The most common symptom of the benign urachal mass was abdominal mass (36%). Seven patients underwent computed tomography (CT) and no calcification was found. All 11 patients were treated successfully by mass excision. Twenty-two cases (67%) had urachal carcinomas, including 17 cases of adenocarcinoma, 4 of squamous carcinoma, and 1 of transitional cell carcinoma. The most common symptom was gross hematuria (68%) in the malignant urachal mass patients and CT showed calcification in 38% of them (5/13). The overall 5-year cancer-specific survival rate was 45.2%. Nine patients with localized cancer underwent extended partial cystectomy with a 5-year cancer-specific survival rate of 78.3%. The patients with metastatic urachal cancer underwent multimodal treatment with an objective response rate of 50% for chemotherapy and 25% for radiation therapy. The median survival time after metastasis of the 8 cases given multimodal treatment was 14.0 months, 7.5 months longer than that of the 4 cases untreated (6.5 months, P = 0.09). The majority of urachal mass in adults is malignant. CT helps in distinguishing the benignancy from malignancy of urachal mass. Surgical excision affords good course for benign urachal mass. Extended partial cystectomy provides a curative surgical treatment for localized urachal cancer. The prognosis of metastatic urachal cancer is poor. Active multimodal treatment may improve the survival of patients with metastatic disease.