Urachal Cyst Research Articles

Synchronous and multiple transitional cell carcinoma of the bladder and urachal cyst

Incomplete involution of the allantoic duct can result in different pathological forms of urachus which can give rise to inflammation or late malignant changes. Among urachal tumors, adenocarcinoma is most frequent, although other histological types can also be found. The synchronous presentation of a urachal transitional cell tumor, along with recurrent superficial bladder tumors has not been reported previously. We are reporting a 49-year-old male patient in whom transitional cell carcinoma of a urachal cyst was found with recurrent, multiple bladder tumors. The diagnosis of urachal cyst tumor was established according to ultrasonography and computed tomography. Most of the bladder tumors were resected transurethrally while open surgical excision of the urachal cyst with en bloc resection of the bladder dome was performed. Recurrent bladder tumors were afterwards treated with Bacillus Calmette Guerin (BCG) instillations. A year after surgery the patient has no signs of local recurrence or distant metastases of transitional cell carcinoma.

Sigmoid–Urachal–Cutaneous Fistula in an Adult Male

An infected urachal cyst is an uncommon finding in adults. We report the first case of a sigmoid-urachal-cutaneous fistula that resulted from rupture of an infected urachal cyst in an adult male. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments and bowel anastomosis.

Villöses Urachusdivertikeladenom mit Langzeitmukusurie

During embryonic development the urachus connects the bladder with the umbilical cord. The urachus obliterates postnatally. Incomplete obliterations result in urachal cysts which, in the case of a connection to the bladder, are termed urachal diverticula. Urachal tumors are rare. We report on the case of a 46-year-old female patient with a 13-year history of recurrent bladder infections and mucusuria caused by an urachal diverticulum. After surgical resection histologic examination showed a mucus producing, intestinally differentiated adenoma within the diverticulum. This finding explains both the recurrent infections and the 10-year history of mucusuria.

Infection of an urachal cyst during etanercept therapy in juvenile idiopathic arthritis

Etanercept, a tumor necrosis factor (TNF) receptor alpha antagonist is licensed for the treatment in patients affected by polyarticular juvenile idiopathic arthritis, who do not tolerate or had an inadequate response to methotrexate. Infections related to immunosuppression by etanercept are of major concern. We report on a 17-year-old boy with enthesitis-related arthritis who developed a major infection of an urachal cyst 18 months after initiation of etanercept therapy, which required surgery. The urachus had not been symptomatic before.

Laparoscopic Excision of a Urachal Cyst Containing Large Stones in an Adult

Stone-containing urachal cysts are extremely rare in adults. Here, we report the case of a 58-year-old man with a urachal cyst who had lower abdominal pain and urinary frequency. Abdominal ultrasonography and computed tomography showed hyperdense stones in the urachus. He was treated with a laparoscopic excision using a transperitoneal approach. The pathological diagnosis was an inflammed urachal cyst. This rare case illustrates an inflammed urachal cyst containing stones treated with laparoscopy.

Urachal Cyst, a Rare Cyst with Multiple Complications

Urachal cysts are rare, can be one of the forgotten causes of abdominal pain, and can present as adenocarcinoma of the bladder, along with many other presentations. There is a real need for physicians, general surgeons, and urologists to be acquainted with the different presentations and management of this rare condition.

Adenocarcinoma of urachal cyst associated with pseudomyxoma peritonei masquerading as abdominal tuberculosis: A case report and review of literature

A case of 14-year-old girl is reported who presented with features of tuberculous subacute intestinal obstruction. Exploratory laparotomy revealed a urachal cyst associated with pseudomyxoma peritonei (PMP). Histopathology confirmed a moderately differentiated mucin secreting adenocarcinoma of urachal cyst associated with PMP. The adenocarcinoma of urachal cyst associated with PMP is further reviewed.

Spontaneous atraumatic rupture of urinary bladder

Spontaneous atraumatic rupture of urinary bladder is a very rare condition, difficult to distinguish from other causes of acute abdomen. Causes, which have been reported, are:Perforation of an infected urachal cyst,Perforation following augmentation enterocystoplasty,Emphysematous cystitis, Following intra-pelvic gynecological operations,Associated with alcohol abuse,Due to eosinophilic cystitis,Complication of neurogenic bladder dysfunction,In association with carcinoma (TCC),After pelvic radiotherapy,Bladder outlet obstruction THE CASE A 51years old male with a history of multiple sclerosis presented to emergency department at Russells hall hospital with symptoms of acute abdominal pain and rigors.PMH included MS,PVD-left BKA and depression. SH: Previous professional boxer drinks 3-4 units of alcohol daily, smokes 20 cigarettes a day and has long-term urinary catheter. Signs: Lower abdominal rigidity and mass, Sepsis: BP 83/52, HR: 110/min, T: 38 C, Sweaty, rigors, Urinalysis revealed: Nitrite ++, Blood ++++, Protein ++, and Leucocytes ++. However, urine culture showed no growth Laboratory findings: WBC: 19.9, CRP: 221 Initial diagnosis made as sepsis secondary to UTI Because of the persistent hypotension and tachycardia and the presence of lower abdominal mass, abdominal CT scan was arranged, which showed distended bladder, urinary catheter blocked, and extraperitoneal urinary bladder rupture Treatment: Systemic broad-spectrum antibiotics, Drainage of urine via transurethral Foley catheter, admission to SHDU and CVP monitoring, IV fluids and nutritional support. The further course of the disease was: Patient responded to above treatment, CT scan repeated 5 days later showed no pelvic fluid collection and discharged home on 10/7/2007 DISCUSSION Acute bladder rupture is a surgical emergency, which may be rapidly fatal if diagnosis and treatment are delayed. The combination of non-specific symptoms, the absence of trauma history and its very rare occurrence mean that initially a spontaneous bladder rupture may not be suspected. Multiple sclerosis is characterized by disseminated patches of demyelination in the brain and spinal cord. Urinary dysfunction and difficulty in bladder control (urgency, hesitancy, retention or incontinence) are some of the symptoms Decreased sensation of bladder filling may play roles in the mechanism of rupture, triggered by urinary retention A CT scan or retrograde cystography would provide the diagnosis. Extraperitoneal vesical perforations can be resolved with a vesical catheter or cystostomy. Spontaneous atraumatic rupture of urinary bladder 2 of 3 Figure 1 Extravasation of the infected urine may result in a perivesical abscess, septic shock, and abdominal and thoracic wall phlegmone. Early surgical management should be considered in these cases.The attached CT images of the same patient: First one showing the extraperitoneal fluid .Second showing gas in the bladder CORRESPONDENCE TO Firas Arnaout Russells Hall Hospital Dudley West Midlands DY1 2HQ Email: firasarnaout@doctors.org.uk References r-0. Emergencies in Urology Hohenfellner M Santucci R r-1. http://www.emedicine.com r-2. Campbell-Walsh Urology Wein A J Kavoussi L R r-3. Bladder rupture caused by spontaneous perforation of an infected urachal cyst,Maruschke M, Kreutzer HJ, Seiter H. Urologe A. 2003 Jun;42(6):834-9. Epub 2003 Feb 7 r-4. Four cases of spontaneous rupture of the urinary bladder,Amano T, Miwa S, Takashima H, Takemae K. Hinyokika Kiyo. 2002 Apr;48(4):243-5. Links r-5. and Medical Association, 25-October-2002, No 1164 Spontaneous atraumatic rupture of urinary bladder 3 of 3 Author Information Firas Arnaout Russells hall Hospital

MRI study in urinary abnormalities of fetus

Objective To illustrate the important complemental function of MRI in dignosing the urinary abnormalities of the fetus by analyzing MR features.Methods MRI findings in 34 fetal urinary abnormalities were retrospectively analyzed.Results Upper urinary tract dilatation was found in 12 cases: one case presented obstructed right renal dysplasia and was on the follow-up,postnatal MR imaging proved the duplex anomaly in one case,one case showed left PUJO on postnatal US imaging and prepared to surgery,7 cases were normal on postnatal US imaging,2 cases were lost to follow up.Bilateral urinary anomalies were found in 7 cases:Multicystic renal dysplasia(n=3),Combined horseshoe kidney in 2 fetuses and bilateral renal aplasia in one case.Bilateral renal dysplasia was diagnosed in 2 cases,one was still born and proved by autopsy and the ohter was lost to follow up.The case of bilateral renal agenesis displayed the appearance of sirenomelia on general specimen.The case of right renal agenesis associated contralateral kidney dyspalsia(n=1)was lost to follow up.MR imaging showed low signal intensity of lung and oligohydramnios in the bilateral anomalies.Unilateral urinary anomalies was found in 15 cases, including 9 cases of unilateral renal dysplasia.Two fetuses were aborted and 3 fetuses were proved with postnatal US or MR.One was lost to follow up;3 cases were on the follow-up.There were 4 cases of unilateral renal agenesis,two fetuses were aborted and 2 fetuses were proved with postnatal US or MR imaging.The case of ectopic kidney was proved with postnatal US imaging.One case of urachal cyst was aborted without autopsy.In the unilateral anomalies,the volume of amniotic fluid was normal,and the fetal lung presented homogenious high signal intensity.Conclusion As a complemental method,MRI is of great value in displaying and dignosing the urinary abnormalities of fetus.

A diagnostic algorithm for urachal anomalies

Objective Urachal anomalies are rare. Variable presentations can be a diagnostic challenge. We combine our series with a review of literature to delineate the most common presentations, highest yield diagnostic studies and a diagnostic algorithm. Methods We reviewed records of 22 boys and 15 girls with the diagnosis of a urachal anomaly from 2000 through 2005. This revealed 19 cysts, seven patent urachuses, five sinuses, four patients with unspecified “urachal anomalies,” and two patients with no urachal anomaly by surgical exploration. Ultrasound was the most common diagnostic study, followed by computed tomography (CT), voiding cystourethrogram and sinogram. Thirty-five of 37 patients underwent surgery. Results Clinical presentation included periumbilical leakage in 54%, pain in 30%, periumbilical mass in 22% and irritative voiding symptoms in 14%. In many patients diagnosis was made on clinical examination alone. When an ultrasound was used it was diagnostic for 82% of cysts, 100% of sinuses and 100% of patent urachuses. A voiding cystourethrogram was diagnostic for 100% of patent urachuses, but less successful in the other anomalies. CT scans correctly diagnosed 71% of cysts. Overall complication rate was 9%, all wound infections. Conclusion Reviewing the results of this and four other large series showed that the most common anomaly is the urachal cyst followed by urachal sinus and patent urachus. Periumbilical drainage is the most common presentation. Physical exam alone can be diagnostic. When this is not possible ultrasound is our recommended initial study, followed by a CT scan if unsuccessful.

P26.01: Prenatal diagnosis of a patent urachus cyst associated with umbilical cord pseudocyst using 3D, 4D ultrasound and fetal magnetic resonance imaging

F. Fuchs1, O. Picone1, M. Mabille2, A. L. Delezoide3, R. Frydman1, M. V. Senat1 1Service de Gynecologie-Obstetrique et Medecine de la Reproduction, Hopital Antoine Beclere, Universite Paris-Sud, Clamart, France, 2Service de Radiologie. Assistance Publique Hopitaux de Paris, Universite Paris Sud., France, 3Service d’Anatomopathologie, Assistance Publique Hopitaux de Paris, Universite Paris Sud., France

Complete excision of urachal cyst by laparoscopic means: A new approach to an uncommon disorder

Anomalies of the urachal remnant are rare. Urachal cysts are usually asymptomatic, however, when they become infected, they can mimic a wide variety of intra-abdominal pathologies. We present two patients in which an urachal cyst was found. Two male patients 25 and 38 years old respectively underwent laparoscopic resection of an urachal remnant. In one of the cases the urachal remnant was complicated by infection. Opportune clinical and radiologic diagnose was made in both cases and complete excision of the urachal remnant was carried out by laparoscopic means. The procedures were performed without complications and follow up showed excellent results. Both patients presented very short convalescence with rapid recovery. The treatment of choice for urachal pathology is the complete excision of the complicated lesion. For this matter laparoscopic surgery assures surgical results comparable to conventional surgery adding the advantages of a minimally invasive approach.

Quiste de uraco: diagnóstico diferencial con hidrosálpinx

To review the differential diagnosis between abdominopelvic cysts and urachal cyst and the laparoscopic treatment of this entity. A 23-year-old woman presented a 85 × 25 mm pelvic cyst as an incidental finding on ultrasound examination. Magnetic resonance imaging (MRI) revealed a possible hydrosalpinx. On month later, the patient started complaining of abdominal pain and laparoscopy was indicated. Diagnosis was urachal cyst. Urachal disease tends to be asymptomatic. The most common complication is infection. The diagnostic tests of choice are ultrasound and MRI. Laparoscopy is a useful technique in the treatment of this entity.

Urachal Cyst: Unusual Presentation in an Adolescent After Intense Abdominal Exercise

INTRODUCTION The urachus is a fibrous cord, at the end of the allantois, which extends from the vesical dome to the umbilicus. It is located between the fascia transversalis and the peritoneum. When there is an alteration in the process of involution during early fetal development, various kinds of urachal anomaly may arise, including congenital permeable urachus, urachal fistula, urachal-vesical diverticulum, urachal cyst, and alternating sinus. Very rarely fistulas or cysts may persist; these are observed in 1 in 5000 children and in 1 in 8000 adults. Alterations in this normal evolution may cause the allantoicurachal malformations that are usually diagnosed during the neonatal period after the emission of urine through the umbilicus and that are generally related to the existence of malformations of the urinary tract (vesicoureteral reflux, ureteral or urethral obstructions). Exceptionally, the urachus that has closed normally may reopen in response to local infections or to intense abdominal traumas. We present what appears to be the second case described in the international literature on urachal cysts, one that became evident after a session of intense abdominal exercise, with rupture of the umbilical scar.

Ectopic Liver

Journal of Ultrasound in MedicineVolume 26, Issue 3 p. 377-379 Case Report Ectopic Liver A Unique Prenatally Diagnosed Solid Umbilical Cord Mass Joseph R. Wax MD, Corresponding Author Joseph R. Wax MD [email protected] Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Address correspondence to Joseph R. Wax, MD, MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA.Search for more papers by this authorMichael G. Pinette MD, Michael G. Pinette MD Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this authorAngelina Cartin, Angelina Cartin Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this authorJacquelyn Blackstone DO, Jacquelyn Blackstone DO Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this author Joseph R. Wax MD, Corresponding Author Joseph R. Wax MD [email protected] Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Address correspondence to Joseph R. Wax, MD, MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA.Search for more papers by this authorMichael G. Pinette MD, Michael G. Pinette MD Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this authorAngelina Cartin, Angelina Cartin Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this authorJacquelyn Blackstone DO, Jacquelyn Blackstone DO Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA.Search for more papers by this author First published: 01 March 2007 https://doi.org/10.7863/jum.2007.26.3.377Citations: 11Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume26, Issue3March 2007Pages 377-379 RelatedInformation

The umbilical mass: a rare neonatal anomaly

Umbilical anomalies are a rare presentation in the pediatric patient. The differential diagnosis includes anomalies resulting from urachal and vitelline duct derivatives such as urachal sinus, urachal cyst, urachal diverticulum, patent urachus, herniated Meckel's diverticulum, umbilico-enteric fistula, or umbilical polyp. In this article, a case presentation of an umbilical anomaly along with the differential diagnosis and management options are discussed. Based upon this review of the literature, the authors propose a management algorithm for treating children with umbilical anomalies.

Perivascular epithelioid cell neoplasms (PEComas): four malignant cases expanding the histopathological spectrum and a description of a unique finding

Four cases of malignant PEComas were stained with smooth muscle actin, muscle specific actin, desmin, human melanoma black-45, melan-A, microphthalmia transcription factor, S100 and cyclin D1. One case was studied by electron microscopy (EM). Tumour locations were the thigh, elbow, retroperitoneum and bladder in association with a urachal cyst. There were two men and two women; the average age was 51.3 years, and the size ranged from 5.0-23.0 cm. In three cases, 50-95% of the tumour was composed of pleomorphic sarcomatous areas. All cases had at least focal clear-cell areas. One case showed a continuous single layer of perivascular clear cells remote from the tumour, transitioning to invasive nests and to PEComa. EM demonstrated these cells in apposition to and in direct contact with the abluminal surface of the basal lamina of the capillaries. We suggest the term "pecosis" for these areas. All cases were positive for two or more melanocytic markers and for at least one actin. S100 and desmin were focally positive in one case. Cyclin D1 was positive in 3:4 cases. Four cases of malignant PEComa are described with the existence of a unique lesion (pecosis) in one case. These tumours may manifest largely as sarcomas appearing to be undifferentiated and should be considered in their differential diagnosis.

Abscess formation as a complication of a ruptured urachal cyst

The urachus is a midline tubular structure that extends upward from the dome of the bladder toward the umbilicus. This tubular structure normally involutes before birth, remaining as a fibrous band with no known function. Persistence of all or any portion of the fetal urachus results in several anomalies, the most common of which is the urachal cyst (Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ, Radiographics, 21:451-4611, 2001; Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003). Although most urachal cysts are asymptomatic, there are a few reports about intraperitoneal rupture of infected urachal cysts, all of which caused peritonitis and sepsis (Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003; Kojima Y, Miyake O, Taniwaki H, Morimoto A, Takahashi S, Fujiwara I, Int J Urol, 10:174-176, 2003; Agatstein EH, Stabile BE, Arch Surg, 119:1269-1273, 1984). We report the imaging and operative findings of a patient, presented with a urachal abscess after a spontaneously ruptured urachal cyst.

Laparoscopic management for urachal cyst in a 9-year-old boy

We report a boy with urachal cyst managed laparoscopically. A 9-year-old boy was referred from another hospital with a history of low abdominal pain. We laparoscopically excised the urachal cyst, removing all structures within the umbilicovesical fascia, including the urachus and each medial umbilical ligament, as well as the associated peritoneum from the umbilicus to the bladder dome. Laparoscopic management of urachal disease can be performed safely, with minimal postoperative pain, excellent cosmetic results and early ambulation. We advocate the use of laparoscopic treatment of urachal anomalies in children.

Allantoic remnants presenting as a giant retroperitoneal cyst

Urachal anomalies are usually found in early childhood or just after birth. These usually involve patent ductus urachus, urachal cyst, umbilical-urachal sinus or vesicourachal diverticulum. Very rarely are urachal anomalies found in adults, usully as an infected urachal cyst. We are presenting a case of surgically removed giant urachal retroperitoneal cyst that was found by chance during the abdominal ultrasound examination of a 22 year old man who was initially treated for idiopathic hypertension.