Diagnosis and Management of Urachal Anomalies in Children

Abstract

Congenital urachal anomalies are present in less than 2 % of the general pediatric population. While traditionally thought of as pre-malignant, their clinical significance particularly in the asymptomatic patient has been questioned. The presence of a urachal anomaly in childhood does not appear to confer an increased risk of urachal cancer in adulthood. These remnants are classified based upon their anatomic location and communication with either the umbilicus or bladder and may present with a variety of symptoms. When clinical signs and symptoms suggest the presence of an urachal anomaly, ultrasonography is the most appropriate initial diagnostic imaging test. Observation with or without follow-up imaging is an acceptable initial step in management as these often regress without surgical intervention particularly in asymptomatic patients. When infectious symptoms are present, a course of antibiotics may be recommended prior to surgery to reduce the chance of postoperative wound infection.

Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature

“…Knowledge on the negligible role of retained urachal anomalies in developing future urachal carcinogenesis [ 1 , 17 ] may also be considered in agreement with a conservative approach of UA during the first year of age.…”

“…The urachus represents an embryological remnant of the cloaca and the allantois. This tubular connection between the primitive bladder dome and the umbilicus normally involutes around the fourth or fifth gestational month, forming the median umbilical ligament in the preperitoneal space of Retzius [ 1 ]. Obliteration of the lumen may be disturbed at any point along the tract, resulting in different morphological variants of urachal anomalies [ 2 ].…”

“…Currently, there is no clear consensus regarding the optimal management of pediatric UA, especially in asymptomatic cases. Surgical removal has been advocated as a standard of care for years, preventing its potential malignant transformation later in life or its symptomatic recurrence [ 1 ]. More recently, others proposed a delayed surgery after failed resolution of patent urachus on repeated imaging after six to twelve months of age, or surgical intervention in symptomatic cases only [ 3 ].…”

Infected urachal cyst: an uncommon cause of severe sepsis in a neonate

“…7 8 However, most authors recommend early drainage of the infected abscess and excision of the urachal remnant as the definitive treatment. [9][10][11][12] Urachal cyst is a benign disease that can be lifethreatening. We suggest that a complete urachal excision as soon as possible remains the best choice.…”