Urachal Anomalies Research Articles

Excretory urography can track down morphological changes in the urinary bladder associated with urachal anomalies in calves for early diagnosis.

To investigate radiographic detection by excretory urography of morphological changes in the urinary bladder associated with urachal anomalies in calves. Excretory urography was performed to detect morphological changes in the urinary bladder of 13 calves, of which 6 were nondysuric with swelling of umbilical region and 7 were dysuric without clinical umbilical swelling from November 2022 through April 2024. The urinary bladder was delineated in all 13 calves after excretory urography. The aspect ratios (length:height), which objectively evaluate the shape of the urinary bladder, ranged from 1.08 to 2.43 (1.90 in average) and 1.34 to 11.89 (4.75 in average) in nondysuric and dysuric calves, respectively. The ratios of calves with nondysuric were significantly lower than those of dysuric (P < .05). Excretory urography could play an important role in evaluating abnormal morphological changes due to urachus anomalies in the urinary bladder of calves. Among calves with dysuria, urachal anomaly should be included in the differential diagnosis. Excretory urography is proposed as an alternative option for early diagnosis among calves presenting with dysuria to improve livestock productivity.

Detection of Urachal Anomaly during Prenatal: A Newborn Case Report

The urachus is the remnant of the cloaca and allantois that has remained since the embryological period. If this remnant does not close in the early period, congenital urachal anomalies, such as patent urachus, urachal cyst, urachal sinus and urachal diverticulum occur. Congenital urachal fistula is a rare type of these anomalies. This case report presents a newborn born at 38 weeks and four days of age, weighing 2820 grams. A healthy-term baby, whose urachus anomaly was detected during the antenatal period, was admitted to the neonatal unit for follow-up and treatment. The patient, who had urine discharge from the umbilical region, was diagnosed with a urachal fistula. The patient was operated on by pediatric surgeons on the 7th day of his life.

Urachal abnormalities in the adult population. Is physical activity involved in clinical manifestation Literature review

Introduction The urachal anomaly is a developmental defect, a remnant of fetal life consisting of a patent connection between the dome of the urinary bladder and the umbilicus. It can take various forms. Most commonly it occurs in males, very rarely in adults. The main symptoms associated with this condition are: foul-smelling discharge from the umbilicus, abdominal pain, hematuria, or recurrent urinary tract infections. Imaging plays a crucial role in the diagnosis of the persistent urachus. Aim of the studyThe aim of the study is to sentize doctors’ attention that patent urachus is the rare but possible diagnosis of acute abdomen pain in adults population and bring the proceedings.Materials and methods: An analysis of papers avaliable on Pubmed and Google Scholar was performed. The following key words: urachal anomalies, adults, abdomen pain, urachal remnants, urachal carcinoma were used.Results:Lately, thanks to modern precise imaging diagnostics, more valuable studies have been conducted, allowing to characterize residual ureteral remnants, which are most often asymptomatic in population of adults. However the manifestation of symptoms is mostly associated with infection of the mentioned area or a tumor transformation. There are at least two case reports which report that infection of urachal remnants could manifestate after intensive physical activity. It is worth in-depth interviewing. Studies indicate the necessity of surgical removal of persistent urachal anomalies, as they carry the risk of rapid growth and unfavorable prognosis of cancerous spread.

Omphalomesenteric Ducts and Urachal Remnants: A Retrospective Study and Case Series.

The management strategies for umbilical disorders remain undefined. This study aims to review our experience and propose a management algorithm for symptomatic urachal and omphalomesenteric duct anomalies. We retrospectively reviewed medical charts between January 2013 and September 2017 of 28 patients with clinical concern for umbilical disorders, out of which 10 were diagnosed with omphalomesenteric duct remnants (OMDR) or urachal remnants (UR). We assessed patients' sex, age at operation, initial presentation, imaging findings, surgical approach, histopathological findings, and prognostic outcome. Among 10 patients with OMDR or UR, initial presentations were omphalitis in four, umbilical discharge in three, abdominal pain in two, and umbilical mass in one. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and voiding cystourethrography were performed in 10, seven, three, and four patients, respectively. Transumbilical extraperitoneal excision from a small expanded umbilical incision and laparoscopic approach combined with transumbilical excision was performed in eight and two patients, respectively. Postoperative wound infection occurred in 10% of patients. Ultrasonography was mostly used as an initial diagnostic modality, and in cases in which there were signs of infection, they were drained adequately; CT/MRI was chosen for further evaluation of suspicious cases for other complications. Thus, we recommended surgical excision in cases with persistent umbilical disorders. The umbilical approach displays good cosmetic results with easy, complete excision, and the laparoscopic approach could be an excellent diagnostic and therapeutic method for the management of complicated conditions.

A rare case of infected urachal cyst leading to intestinal obstruction in a 3-month-old boy with febrile urinary tract infection: Case report.

Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst. A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension. Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction. Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed. The day after surgery, the patient was discharged without any complications. Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.

Urachal remnants: from embryology to clinical practice.

The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament. Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50-52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3-5%). Ultrasound scan is the most commonly performed diagnostic imaging study. In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy.

Persistence of Urachus in A 7-Month-Old Male Patient with Surgical Resolution: Case Report

Introduction: Patent urachus refers to a rare condition called urachus anomaly. These conditions are caused by the failure of the normal fetal tissue used to empty the fetal bladder to degenerate. Some of these urachal abnormalities are obvious at birth, while others are more subtle and are not diagnosed until adulthood or are discovered only incidentally after imaging for other reasons. Urachal anomalies in children with wet umbilical cord, persistent drainage, recurrent urinary tract infections, and recurrent umbilical cord infections require accurate and timely diagnosis to help relieve symptoms, prevent recurrent serious infections, and ensure timely treatment. Clinical case: The case of a 7-month-old male patient is presented. The mother reports umbilical granuloma of several months of evolution. He goes to a doctor where he suggests an ultrasound examination that rules out persistence of urachus. Mass in umbilical region persists, which is why she comes again. Evolution: By laparoscopic vision, umbilical hernia plus persistence of urachus is evident, findings such as the presence of indirect bilateral inguinal hernia are found. After surgery, the patient recovered satisfactorily. Conclusions: Diagnosis of urachal anomalies can be elusive, but continued drainage of the umbilical cord is a concern in the case of urachal anomalies. Although this condition is usually an isolated finding, the possibility of posterior urethral valves in infants with a patent urachus should not be ruled out.

Infected Urachal Anomalies: Clinical Features and Bacteriological Studies

Infected Urachal Anomalies: Clinical Features and Bacteriological Studies

Urachal Anomalies During Infancy: A Case Series

Urachal Anomalies During Infancy: A Case Series

Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery

Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. All patients diagnosed with a UA from 2016 to 2020at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p<.0001). Though, urology was more likely to treat patients who presented incidentally (p<.01), and general surgery was more likely to treat patients who presented with an infected remnant (p<.01). Patients of male sex were more likely overall to receive surgery compared to female patients (p<.01). Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.

Intravesical urachal cyst masquerading as a bladder malignancy: a case report

BackgroundUrinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties.Case presentationA 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms.ConclusionsIntravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.

Pseudomembranous cystitis in cats with presumed or confirmed mineralization: A retrospective study of 26 cases (2016-2021).

Pseudomembranous cystitis (PMC) in cats is a recognized disease, but concurrent mineralization is reported rarely and its outcome is poorly described. Describe a population of cats with PMC and the prevalence of concurrent mineralization. Twenty-six cats with PMC. Medical records were retrospectively reviewed (January 2016 to December 2021). Cats with an ultrasound diagnosis of PMC were included. Clinicopathologic results, imaging, treatment, and outcome were reviewed. All cats were male and 21 (80%) were diagnosed with urethral obstruction (UO). Five cats (23.8%) had positive urine culture (Staphylococcus felis, 3/5; Proteus mirabilis, 2/5) with a median urine pH of 8 (range, 6-9). All cats had ultrasonographic changes suggestive of mineralization. On ultrasound examination, 10 cats (38.5%) had pseudomembranes with acoustic shadowing suggestive of mineralization, 15 (57.7%) had changes indicative of ulceration, and 8 (31%) had changes compatible with of a urachal anomaly. Twenty-two cats received medical treatment, 4 underwent surgery (3 percutaneous cystolithotomy, 1 cystotomy). Twenty cats (77%) survived to discharge. Follow-up ultrasound examination indicated resolution of PMC in 6/7 cats, 4 had persistent hyperechoic bladder lining. Five of 12 cats with follow-up had a relapse of lower urinary tract signs. Pseudomembranous cystitis was diagnosed mainly in male cats with UO and imaging findings suggestive of mineralization were present in all cases. Frequent negative urine culture suggests a different etiology than encrusting cystitis related to urease-positive bacteria. Good outcomes can be achieved with medical management.

Successful surgical treatment of omphalocele with umbilical evagination of the bladder: an extremely rare presentation of neonatal case

BackgroundA few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have indicated the existence of urachal anomalies and umbilical cysts related to bladder evagination. The incidence of urachal anomalies at birth is reported to be 1 in 5000–8000 live birth, and urachal aplasia is rare. Herein, we report a rare, novel case of urachal aplasia.Case presentationWe encountered a small omphalocele with bladder evagination associated with urachal aplasia for which the neonate underwent surgery one day after birth. The patient was a one-day-old boy with a prenatally diagnosed omphalocele. A fetal magnetic resonance image (MRI) scan (25 weeks of gestation) revealed a 30 × 33 mm (approximately 1.3 in.) cystic lesion which was suspected to be an umbilical cyst. The baby was born vaginally at 38 weeks, weighing 2956 g. An omphalocele (hernial orifice diameter, 4 cm × 3 cm) with bladder prolapse was recognized. After sac excision, the prolapsed bladder was resected and closed with two-layer sutures. In order to secure sufficient bladder capacity, we estimated the minimum residual volume as 21 ml after bladder plasty. The remaining bladder capacity was confirmed to be 30 ml by injecting a contrast dye and saline into the bladder. The neonate had no associated cardiac urogenital or skeletal anomalies. Postoperative course was uneventful. The patient was regularly followed up for two years after surgery and underwent umbilicoplasty. He had no trouble with urinary function.ConclusionIn this case, we experienced extremely rare condition of a small omphalocele with bladder evagination associated with urachal aplasia and reviewed 7 case reports of anomalies similar to those in the present case. Umbilical cord cysts may be an informative indicator of these symptoms in utero. Therefore, ultrasonography scans should be conducted until delivery, despite the spontaneous disappearance of cord cysts.

Surgical management of benign noninfected urachal cysts in adult patients: two case reports

BackgroundAbnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition.Case presentationHerein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts.DiscussionLaparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach.ConclusionManaging persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.

Current management strategies of urachal anomalies in pediatric patients: A scoping review

IntroductionManagement of urachal anomalies in pediatric patients has historically lacked a clear consensus between conservative and surgical management. We aimed to review and summarize the literature on the diagnosis, symptoms, and evolution in the management of urachal anomalies in pediatric patients.MethodsWe performed a scoping literature review of PubMed/Medline and WebOfScience from January 2000 to February 2022.Results32 publications were selected for inclusion in this analysis. 1,438 unique studies were identified with 32 studies meeting inclusion criteria. 15/32 studies discussed both conservative and surgical management, 14/32 studies discussed only surgical management outcomes, and 3/32 studies discussed diagnostic methods. The studies discussing conservative management supported the treatment of urachal anomalies with an initial conservative approach, which includes watchful waiting, repeated ultrasounds, lesion measurement, and antibiotic use. 5/32 of the included studies identified patients that were converted from conservative to surgical management with conversion rates ranging from 12.5% to 43.5% per study. 14/20 converted patients were identified to have a urachal cyst and 13/20 had a persistent infection.ConclusionsStrong evidence exists that supports initial conservative management over surgical management of pediatric urachal anomalies. However, predictive factors for determining which patients will require surgical management remain elusive. Treatment algorithms can potentially be developed once carefully developed prospective studies delineate statistically significant patient factors which necessitate surgical management over observation.

Meckel’s diverticulitis with abscess presentation in an acute abdomen

The vitellointestinal/omphalomesenteric duct is embryonic structure connecting primary yolk sac to the embryonic midgut which obliterates by 10th week of gestation. It may persist or incompletely obliterate to form anomalies like Meckel’s diverticulum that is most common and is usually asymptomatic. Symptoms develop when Meckel’s diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. The modalities useful in diagnosing it are ultrasonography (USG) and computed tomography (CT), USG being more easily available, and radiation free is the first modality useful to suspect these anomalies. It can mimic close differentials such as appendicitis and urachal anomalies. In this case report, a 12-year-old male child presented with recurrent periumbilical pain who was screened on USG was suspected Meckel’s diverticulitis with abscess; the same was confirmed on contrast CT scan and managed surgically. This case shows the importance of USG and radiologist’s suspicion of Vitellointestinal duct anomalies in diagnosing and its associated complications.

URACHAL ANOMALIES IN CHILDREN (ANALYSIS OF MEDICAL LITERATURE AND OWN OBSERVATIONS)

Currently, a significant number of publications have been accumulated on the disorders of urinary duct, urachus involution. However, the world literature data on the timing of obliteration and the frequency of urachal anomalies vary significantly, which makes it difficult to assess the risk of complications. There is also no consensus on the tactics of management of these patients. This paper analyzes 62 medical sources on the issues of urinary duct involution, disorders of its obliteration, clinical manifestations of urethral complications and treatment of related conditions. The article also presents data of our own observations of 37 patients with various urachal pathology over a ten-year observation period, including 21 (56.76%) children had umbilical fistulas, 14 (37.84%) children - urachal cysts, 2 (5.4%) patients - bladder diverticula. The data of diagnosis and treatment of children with this pathology are presented.Purpose: analysis of medical sources and own data on the diagnosis and treatment of urinary duct pathology in children, highlighting important and practically significant recommendations on problematic issues of this pathology.Conclusions.1. Urachus is an embryonic formation that connects the bladder with the allantois. According to pathological and anatomical studies, impaired obliteration of the urinary duct occurs in approximately 30% of cases.2. The presence of discharge from the umbilicus, recurrent omphalitis, the presence of a tumor-like mass of the anterior abdominal wall, symptoms of urinary tract infection should be indications for targeted examination for possible urethral pathology.3. The main methods of diagnosing the pathology of the urinary duct are ultrasound and fistulography.4. Data on the age involution of urachus, which occurs in the postnatal period, determine the need to choose the treatment tactics in childhood.

Current management of the urachal anomalies (UA). Lessons learned from the clinical practice.

It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the clinical presentation, the efficacy of current modalities used, and postoperative pathology in patients with UA. We have performed a retrospective review of all patients diagnosed with UA and treated surgically or conservatively over 18years. Demographic data, clinical presentation, imaging modalities, pathology, treatment, and postoperative complications were analyzed. Twenty-five symptomatic patients (18 males and seven females) with a median age of 13years (1month to 37years) were identified. 15 (60%) were diagnosed with a urachal cyst, 4 (16%) with sinus, 3 (12%) with urachal diverticulum, and the remaining 3 (12%) with patent urachus. Of those, 20 (80%) underwent surgical repair, and the remaining five (20%) patients were managed conservatively. 4 (20%) underwent laparotomy, 7 (35%) laparoscopic incision, and the remaining 9 (45%) laparoscopic robotic-assisted surgery. Nine patients required bladder cuff excision. The median operative time was 75min (42-140min). One patient developed Clavien-Dindo grade IIIA complication resulting in infected hematoma, which resolved after drainage. Another patient with a complication of grade IIIB needed reoperation as a result of recurrent events of an abscess. 13 (65%) demonstrated epithelium lining of the urachus on postoperative pathology. Our data show that most of the patients with UA presented with epithelial lining, which might lead to the later malignant transformation. It might cause a shift from the conservative management of asymptomatic patients to surgical intervention. Robotic-assisted surgery appears beneficial in these patients, especially when the bladder cuff excision is required.

A RARE PRESENTATION OF INFECTED URACHAL SINUS IN AN ADULT – CASE REPORT

Urachal anomalies are infrequent in adult population. Few cases of urachal sinuses are reported and are usually asymptomatic unless a complication occurs, most likely infectious. Clinical manifestations include purulent umbilical discharge, abdominal pain and periumbilical mass. We report a rare case of late presentation of an infected urachal sinus in a male adult. Antibiotic therapy was followed by surgical excision. Histological examination revealed no signs of malignancy.

Urachal Remnants and Anomalies in Children: Rationales of Surgery

Urachal Remnants and Anomalies in Children: Rationales of Surgery