Introduction:
The part of the channel between the urinary bladder and the belly button, from where urine drains during the initial stages of the pregnancy, is called urachus. Urachal anomalies are rare and mostly present in early childhood. Urachal cysts, urachal sinus, and patent urachus are the types of urachus anomalies. Surgical management is the treatment of the choice for urachus anomalies. The common urachus disorders seen in the patients are gastrointestinal and other genitourinary anomalies. Diagnosing the urachus anomalies is difficult in the absence of the symptoms. Complete surgical excision of the urachal abnormality with a bladder cuff is recommended to avoid recurrence or development of carcinoma in resected tissue. Prognosis is usually poor due to its late presentation with local invasion. This article will discuss surgical treatment of urachal anomalies.
What Is Urachus?
The urachus is a remnant part that arises before birth extending between the bladder and the umbilicus. During normal gestational (nine-month pregnancy) development, the urachus involutes, and its lumen is obliterated, becoming the median umbilical ligament. Urachal anomalies result from a failure of the developing urachus to completely obliterate its lumen and represent uncommon and often underdiagnosed entities. Urachal anomalies may be found incidentally at imaging or urinary symptoms. The persistence of undetected urachal anomalies may cause abdominal or urinary complications in both children and adult populations due to inflammation and infection.
Sometimes urachal anomalies can result in cancer. The reported incidence of urachal anomalies is approximately one in 5000 population for adults, with a significantly lower rate of one in 150000 population among infants. There is a higher prevalence in men than women. Most anomalies of the urachus are unexpected and rare, being detected incidentally and more frequently with the increased use of cross-sectional imaging.
What Are Urachus Anomalies?
Urachal anomalies refer to a group of medical conditions that occur when the urachus fails to close off properly after birth. These anomalies can lead to various complications, such as infections, inflammation, and even cancer.
The following are the common urachal anomalies:
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Patent Urachus - This is the condition in which the whole tubular structure of the urachus remains intact. This occurs due to failure of urachal sealing; due to that, there is an existing channel between the bladder and umbilicus. This can cause leakage of the urine. The treatment of the condition is complete excision of the urachus. A definitive diagnosis of patent urachus can be made with imaging.
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Urachal Sinus - The condition in which the urachus fails to seal and creates a tract from the umbilicus into the urachus is called urachal sinus.
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Urachal Diverticulum - The condition in which urachus fails to seal and tract is created from the bladder into the urachus is called urachal diverticulum.
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Urachal Cyst - The most common urachal anomaly is a urachal cyst, which is a fluid-filled sac that develops in the urachus. Urachal cysts are usually asymptomatic but can cause pain or infection if they become inflamed or infected. The condition where both ends close but the central portion remains open is called a urachal cyst. Cysts are usually small and asymptomatic. The diagnosis is often made only when they become symptomatic in childhood or adulthood because of complications, mainly infection, or as an incidental finding at imaging performed for unrelated reasons.
What Are the Symptoms of Urachal Anomalies?
The following are the symptoms of urachal anomalies:
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Generalized pain in the abdomen.
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Severe lower abdomen pain.
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Lower abdomen redness.
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Drainage.
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Hemorrhage (bleeding).
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Burning sensation in urination.
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Peritonitis (inflammation of the abdominal wall).
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Infection.
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Internal bleeding.
How to Diagnose Urachus Anomalies?
Diagnostic tests need not be extensive, but detection of the important associated anomalies is essential since they can be more of a health hazard than the urachal defect itself.
The following are the ways to diagnose the urachal anomalies:
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Radiographs - X-rays help to diagnose a patent urachus.
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Physical Examination - Urachus can be diagnosed by physical examination.
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Cystogram - Cystogram or sinogram may be useful in confirming the diagnosis.
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Ultrasound - Ultrasound is an invasive technique which is helpful in diagnosing urachal cyst and urachal diverticulum.
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Computed Tomography(CT) - CT scan provides the diagnosis in patients. However, its use should be limited to patients in whom a malignant (cancerous) urachal anomaly is suspected.
How Are Urachal Anomalies Treated?
Surgery for anomalies of the urachus typically involves the complete removal of the urachus and any surrounding tissues that may be affected. Surgical repair should be undertaken at the time of diagnosis since it is rare that these conditions resolve spontaneously. The surgical approach may vary depending on the location and size of the anomaly.
In some cases, minimally invasive procedures may be used to remove the urachus, while in other cases, open surgery may be necessary. Recovery time following surgery for urachal anomalies can vary depending on the extent of the procedure and the overall health of the patient. Anomalies extending to the bladder (patent urachus) require excision of the remnant and placement of a bladder cuff to prevent long-term complications. Surgical excision of asymptomatic urachal anomalies has been proposed to prevent complications, mostly to prevent the development of malignancy. There are limited benefits of prophylactic excision in the presence of an asymptomatic lesion.
Patients may experience pain, discomfort, and limitations in their physical activities for several weeks following surgery. They may also need to undergo regular follow-up appointments and imaging studies to monitor their recovery and ensure that the anomaly does not recur.
Conclusion:
Urachal abnormalities are rare. The optimal diagnostic radiographic study depends on the presentation. Any child who presents with a periumbilical mass should be suspected of having a urachal cyst, and an ultrasound should be performed, which is usually diagnostic. Surgery is often necessary to address anomalies of the urachus. Urachal cysts, sinuses, and cancer can cause significant health problems if left untreated, and surgical removal of the affected tissues is typically the most effective treatment option. Patients should discuss the risks and benefits of surgery with their healthcare provider and carefully follow all postoperative instructions to ensure a successful recovery.
