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Objective: To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children., Patients and Methods: A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records., Results: Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months., Conclusion: With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Urachal cysts are uncommon. Rarely, these cysts can become infected. Tuberculosis of the urachal cyst is exceedingly rare, with only one case reported previously in the English language literature. Here we report the case of a 23-year-old male who presented with an infra-umbilical mass that turned out to be tuberculosis of the urachal cyst.

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

Introduction: Symptomatic urachal anomalies are rare disorders that consist of urachal remnants or fistulas with or without an associated cyst. Traditionally, when a urachal anomaly was recognized, operative excision was performed. There has been a shift toward the nonoperative management of urachal anomalies at many centers, although there is little in the literature to support this practice., Methods: A retrospective chart review of patients with urachal anomalies was performed from January 2002 to March 2008. Children with a draining umbilicus and no radiographic or surgical confirmation of a urachal anomaly were excluded., Results: Fifteen patients with symptomatic urachal anomalies were identified. The average age was 3.5 years (4 weeks to 14 years). Symptoms included umbilical drainage (n = 10), abdominal pain (n = 6), omphalitis (n = 4), intraabdominal mass (n = 3), dysuria (n = 1), recurrent urinary tract infections (n = 1), and fever (n = 4). The diagnosis was confirmed by ultrasound (n = 13) and/or computed tomographic scan (n = 4). The surgically treated cases included 7 urachal cysts (5 uninfected, 2 infected) and 1 patent urachal fistula. Mean follow-up is 37 months, and there have been no reported recurrences. Those treated without surgical excision included 4 patent urachal fistulas (mean follow-up, 20 months-no recurrences) and 3 infected urachal cysts (percutaneous drainage [n = 2] and laparoscopic drainage [n = 1]-no recurrences on ultrasound at 26 months)., Conclusion: Nonoperative management of urachal anomalies is a reasonable approach and may be extended to infected urachal cysts after initial drainage. Infected cysts that are adequately drained seem to obliterate with time. Modern ultrasonography facilitates thorough follow-up. We propose a treatment algorithm for the management of suspected urachal anomalies., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objectives: To report 2 cases of median raphe cysts, 1 in the penis and the other in the perineum., Method: Two cases of median raphe cyst are described; the first was treated by surgery and the second required no treatment., Results: The surgical patient experienced no complications and was asymptomatic with no recurrence at 2 years., Conclusions: Median raphe cysts are a rare, benign condition of uncertain etiology. Treatment consists on simple excision.

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.

Cystic hematomas were diagnosed in 3 neonatal foals. In all 3 foals, cystic hematomas resulted from umbilical trauma or thrombocytopenia. Findings in these foals suggest that cystic hematoma should be included in the differential diagnosis of hematuria in neonatal foals. Management of cystic hematomas includes both medical and surgical options.

We encountered 6 patients with pyourachus (male, 1; female, 5) who ranged in age from 17 to 58 years (mean, 41 years) during the 7 years from 1993 to 1999. Three of them had a history of gynecological surgery, and 2 had a history of appendectomy. Improvement was observed in one patient with conservative therapy alone, but the other 5 patients underwent surgery. Preoperatively, 2 patients underwent drainage, one of them through the umbilicus, and the other through a position on the midline percutaneously. Pathological examination in the 5 patients revealed no evidence of cancer. With reference to postoperative complications, adhesive ileus was recognized in 1 case one year postoperatively but no other complications were noted in the other 5 cases. No evidence of recurrence has been seen in any of these patients to date.

A 42-year-old man complained of lower abdominal pain. Computed tomographic scan and magnetic resonance imaging revealed an infected urachal cyst. A drainage catheter, which had multiple holes over a 10 cm length from the catheter tip, was placed in the urachal cyst. The catheter was inserted from the subumbilicus region and the catheter tip was intended to be situated at the caudal end of the urachal cyst. However, the catheter tip accidentally perforated the bladder and urine flowed out of the bladder through the catheter. Because the urine diluted and washed out the pus in the urachal cyst, the infected urachal cyst was successfully drained. Percutaneous drainage and antibiotics allowed resolution of the inflammatory process. On the twenty-third day after catheter placement, excision of the urachal cyst and partial cystectomy were performed with relative ease and without any complications.

Background: We report on an extremely rare case of urachal tuberculosis that was confirmed using a polymerase chain reaction test of paraffin-embedded material., Methods/results: A 62-year-old man presented with pollakiuria. With a diagnosis of urachal abscess, the patient underwent en bloc resection of the cystic mass. A bacterial culture test of the content showed no organism. The histopathologic findings suggested urachal tuberculosis. The AMPLICOR polymerase chain reaction test by using paraffin-embedded sections revealed the existence of Mycobacterium tuberculosis in the resected tissue. The only positive finding in systemic screening examinations for tuberculosis was old tuberculosis scars in the upper right lung. It was supposed that hematogeneous spreading from the lung lesion may result in urachal tuberculosis after a long latent period., Conclusions: Although urachal tuberculosis is an extremely rare condition, tuberculosis must always be kept in mind when observing any infectious diseases.

Urachal conditions are relatively exceptional, cystic formations being the most commonly reported. Urachal cysts remain silent and are not diagnosed except for the presence of associated complications such as: infection, lithiasis, re-permeabilization and malignant degeneration. This paper presents one patient with an infected urachal cyst (pyourachal) which required surgical exeresis. A literature revision is made of the clinical, diagnostic and therapeutic aspects. Emphasis is made on the relevance of a high index of suspicion considering its small incidence, the absence of specific clinical sings and the possibility of mimicking different abdominal pictures. Also the usefulness of ultrasound and computerized axial tomography in the diagnosis, and the need for surgical exeresis, including a vesical cup rim, are emphasised.

During a period of fifteen years, 9 children and 5 adults with a variety of urachal anomalies were treated. Infected urachal cysts were more common in children whereas adults more frequently had infected urachal sinuses. After careful physical examination, a preoperative diagnosis could be made in most patients, with ultrasound examination decisive in doubtful cases. Whenever feasible, complete excision of the umbilicovesical tract is performed, but in very ill patients, a staged treatment becomes necessary. The preoperative injection of methylene blue is helpful in the identification of communicating tracts, all of which should be removed. All affected children should undergo investigation for associated genitourinary anomalies.

We present the manifestations, their recognition, and treatment of urachal disorders, as well as report on 3 cases of urachal abscess in children. A review of the English literature is included.

A total of 17 cases of remnants of urachus were examined between 1981 and 1989, including 2 cases of patent urachus, 5 of urachal cyst, 9 of urachal sinus, and 1 of urachal diverticulum. A long urachal sinus was considered to be caused by the self-destruction of a cyst. While patent urachus was diagnosed in neonates with urine discharge from the umbilicus, cysts or sinuses accompanied by infection were more often found in older children. Imaging of the burrows was diagnostic in 8 out of 11 cases, ultrasound examination in 9 out of 12, and CT examination in all of 3 cases. Since this condition is frequently accompanied by malformations of the urinary system, attention must be paid to locating the accompanying anomalies. Although primary extraction was performed in 13 cases, the primary treatment of cases with highly infected cysts should be drainage, followed by secondary extraction. Furthermore, caution must be exercised to avoid hemorrhage in cases with dilation of the umbilical artery.

Two cases of rare urachal anomalies in the adult are described, including one acquired patent urachus and one giant urachal cyst. The presenting symptoms and signs included pyuria, fever, lower abdominal pain and palpable abdominal mass. The correct preoperative diagnosis was made after sonography. The clinical and radiographic features and magnetic resonance imaging are presented. Stone formation and the huge capacity of the urachal cyst are first reported. Excision of the urachal tract with resection of the bladder dome and cauterization of the cystic wall with stone removal were performed in that order. When a young adult presenting with a wet umbilicus, acute abdominal pain or a lower midline abdominal mass, the possibility of an infected urachal anomaly should be considered in the differential diagnosis.

Persistent urachal remnants are uncommon congenital anomalies. Unless an umbilical fistula exists, infection may be the first indication of this abnormality. Five children received initial treatment for this problem at the Children's Hospital of Buffalo during a 20-year period, 1964 to 1984, and a sixth was seen secondarily. There were four boys and two girls; their ages ranged from 8 months to 9 years. Lower abdominal mass with fever and local tenderness were the most common presenting signs. Ultrasound was the most accurate study, correctly diagnosing the cyst in both patients so examined. Incision and drainage alone was performed in one patient. The other five were managed with antibiotic therapy and complete excision as the primary procedure. Cultures were obtained in five patients and were positive in four, growing Staphylococcus aureus in three and Escherichia coli in one. Significant genitourinary abnormalities were discovered in four of the five patients evaluated. It is concluded that the previously recommended therapy of incision and drainage followed by delayed resection was developed in the preantibiotic era to minimize the mortality from sepsis and the morbidity from recurrence. Our experience indicates that the use of appropriate antibiotics followed promptly by complete cyst excision as a primary procedure is both possible and safe in most cases. Furthermore, the large number of associated genitourinary abnormalities suggests that a complete work-up for these conditions should be performed.

A spectrum of rare urachal abnormalities in the adult is described, including urachal cyst, infected urachal cyst and abscess, and urachal carcinoma. The clinical and radiographic features are presented, and diagnosis using ultrasound, computed tomography, and needle aspiration is discussed. Treatment of infected urachal cysts with percutaneous catheter drainage is described.