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Antecedentes: la persistencia del uraco es una patología poco frecuente. Su diagnóstico y tratamiento oportuno puede impactar en el pronóstico. Reporte de caso: recién nacido a término de 8 días, antecedente de quiste de cordón umbilical, que consulta por cuadro onfalitis, se inició manejo antimicrobiano, se realizó ecografía abdominal evidenciándose imagen compatible con persistencia del uraco. Fue llevada a cirugía con adecuada evolución clínica y completó cubrimiento antibiótico para Klebsiella pneumoniae y Staphylococcus aureus de manera favorable. Conclusión: La persistencia del uraco es una patología poco frecuente que requiere un manejo multidisciplinar para iniciar un tratamiento de manera oportuna. Los quistes de cordón umbilical y la onfalitis están asociados a la persistencia del uraco.

This report presents the case of a rare and aggressive cancer originating from the urachus in a 73-year-old female. After 12 years of observation due to a cystic lesion in the bladder dome, the patient rapidly developed haematuria and mucinuria. The use of multiple diagnostic measures suggested urachal malignancy. Partial cystectomy and urachal excision along with pelvic lymphadenectomy were performed. Urachal adenocarcinoma with negative surgical margins and lymph nodes was reported in pathology. Follow-up after 12 months did not reveal any cancer relapse. Epidemiological, clinical and therapeutic features of this disease are also discussed.

Objective: The aim of this study was to improve understanding the clinical, pathologic, and prognostic features of urachal carcinoma (UrC), a retrospectively descriptive study was done in 2 clinical centers. Methods: After excluding the 2 missed patients, the clinical and pathological data of 59 patients with UrC, who were diagnosed or treated at 2 clinical centers between 1986 and 2019, was retrospectively analyzed. SPSS 22.0 (IBM) and GraphPad Prism 8.0.1 were used for statistics and data visualization. Survival data were analyzed by the Kaplan-Meier method and Log-rank tests. Cox proportional hazards regression were performed for find risk factors on predicting the prognosis. Results: Of all 59 patients, 47 were male and 12 were female. The median age at diagnosis was 51.6 years (range: 22–84 years). Gross hematuria was the most common symptom (79.66%). The majority of urachal neoplasms were adenocarcinomas (94.92%). Forty-two patients (72.41%) underwent extended partial cystectomy with en bloc resection of the entire urachus. The mean follow-up was 52 months (3–277 months). Median overall survival was 52.8 months (4–93 months). The 3-year cancer-specific survival (CSS) rate and 5-year CSS rate were 69.1% and 61.2%. There was no significant difference among localized T stage, tumor histologic grade and surgical procedures in determining prognosis by survival analyze. While patients with high-risk TNM stage (local abdominal metastasis, lymph node metastasis, or distant metastasis) (p = 0.003) and positive surgical margin (p < 0.001) had significantly worse prognosis. Conclusions: The results indicate that high-risk TNM stage and positive surgical margin are risk predictors of prognosis. Localized T stage, histologic grade, and surgical procedure cause no significant effect on patient prognosis. The extended partial cystectomy is the recommended surgical approach for patients with UrC. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

Based on the analysis of literature sources, modern data are presented on the nosological structure of urachus diseases in adults and children, diagnostic methods, as well as treatment tactics for various anatomical variants of anomalies in the development of the urinary duct. A modern classification of urachal malformations caused by disorders of its obliteration is presented. Various modifications of the laparoscopic approach are considered for the most common types of this pathology. The reasons for the development of malignant neoplasms from the urachus tissue, including in the gender aspect, are described, and a comparative assessment of the methods of surgical treatment of urachus tumors is given.

Surgeons should aim for continuous quality improvement. The aim of this study was to evaluate the impact of incremental changes to Robot Assisted Radical Prostatectomy (RARP) technique on intra-operative and early post-operative outcomes. All cases of RARP performed by a single surgeon in a tertiary institution over a 2-year period were included in this evaluation. Routine clinical data were collected. Cases were retrospectively allocated to four groups depending on key technical steps (1 = standard anterior approach; 2 = anterior approach with preservation of endopelvic fascia, puboprostatic fascia and urachus; 3 = posterior approach for nerve spare, with preservation of endopelvic fascia, puboprostatic fascia and urachus; 4 = Retzius-sparing posterior approach). 187 patients were allocated to groups: 1 = 22, 2 = 53, 3 = 90, 4 = 22. There were no significant differences in pre-operative characteristics, except age: 1 = 62.5, 2 = 62, 3 = 62.5, 4 = 58.5 (p = 0.02). Intra-operative differences were found in console time: 1 = 195, 2 = 167, 3 = 195 4 = 136.5 min (p

Urachal carcinomas is a rare and aggressive tumor, accounting for less than 1% of all bladder cancers. We report a case of a 32-year-old man, with no past medical history, complaining of a total hematuria. The abdominal computed tomography scan revealed an exophytic mass of 3 cm on the dome of the bladder, extending to the urachus. The computed tomography scan of chest, abdomen and pelvis did not show neither regional or distant metastasis. Partial Cystectomy with umbilectomy was performed. Histopathology was in favor of urachal adenocarcinoma, classed pT3a, based on Sheldon's staging system, pT2b based on Mayo system, and pT2 based on Ontario system.

ZusammenfassungDie Urachusfistel ist eine Nabelerkrankung des neugeborenen Fohlens. Ätiologisch bleibt entweder der Schluss des Urachus nach der Geburt aus (Urachus persistens) oder der Urachus war bereits geschlossen und öffnet sich zu einem späteren Zeitpunkt wieder (Urachus patens). Häufige Ursachen für eine Urachusfistel sind kongenitale Defekte, das Abreißen des Nabelstrangs oberhalb der Prädilektionsstelle, Traumata, erhöhter intravesikaler oder abdominaler Druck und Nabelinfektionen. Die Urachusfistel wird des Öfteren bei prämaturen oder lebens- und immunschwachen Fohlen beobachtet. Hengstfohlen sind häufiger betroffen als Stutfohlen. Erkrankte Fohlen zeigen entweder direkt nach der Geburt (Urachus persistens) oder meist 7–14 Tage post natum (Urachus patens) typische klinische Symptome wie Harnträufeln während der natürlichen Miktion oder Harnabsatz im Strahl über den Hautnabel sowie eine feuchte Nabelumgebung. Die Diagnose lässt sich i. d. R. eindeutig stellen. Typische labordiagnostische Befunde sind für die Urachusfistel nicht beschrieben. Konservative Therapieversuche mittels Verödung, Kauterisation oder Kryochirurgie können erfolgen, solange keine entzündlichen Veränderungen des Urachus und der übrigen Nabelstrukturen vorliegen und das Urachuslumen bis zu 6 mm beträgt. Eine Nabelresektion ist dann indiziert, wenn ein sehr weites Urachuslumen, eine begleitende Nabelinfektion oder eine Sepsis vorliegt oder wenn sich nach 5–7 Tagen konservativer Behandlungsdauer kein Therapieerfolg einstellt. In den meisten Fällen besteht eine gute Prognose, doch können Komplikationen wie Nabelentzündungen, streuende Infektionen und sekundäre Gelenkerkrankungen die Prognose erheblich verschlechtern.

Objective To report a multicenter experience with the management of urachal abscess treatment in Japan. Methods This was a retrospective study of 263 cases of urachal abscess managed at 12 university hospitals in the Kyushu-Okinawa region over a 10-year period. Age, sex, abscess size, clinical symptoms, type of urachal remnants, and treatment were collected and analyzed. Results The average age was 29.8 ± 18.1 years, with males accounting for approximately two-thirds of the study population. The average abscess size was 1.7 cm (range 0-11 cm). The most common presenting symptom was umbilical secretion (66%), followed by abdominal pain (46%). A total of 127 patients (48.3%) were treated with antibiotics alone, whereas 136 patients (51.7%) received surgical treatment. The surgical approach was laparotomy in 75 patients (61.0%) and laparoscopic surgery in 48 patients (39.0%). Regarding the type of urachal remnant, the urachus sinus (180 patients) accounted for 68.4% of the total. Conclusions To our knowledge, this study represents the first report on urachal abscess treatment in Japan. Our data show that the clinical symptoms might vary depending on the type of urachus remnant. It should be noted that gross hematuria, a characteristic symptom of urachal cancer, is rare in patients with urachal abscess.

Purpose To discuss whether the dome or anterior wall of bladder adenocarcinoma (BAC) should be classified into urachal carcinoma (UrC) and the relationship of primary tumor location (PTL) as well as treatment with survival. Methods Surveillance, Epidemiology, and End Results 18 database was examined for eligible patients from 1975 to 2016. Patients were classified into adenocarcinoma originating from the urachus (UAC), the dome (D‐BAC), the anterior wall (A‐BAC), and the other sites adenocarcinoma of the bladder (O‐BAC). The clinicopathological features, treatment, and survival were compared among the groups. Results Comparable clinicopathologic features were obtained between UAC and D‐BAC, which were different from those of A‐BAC and O‐BAC; otherwise, the latter two had similar clinicopathologic features. Univariable and multivariable Cox regression analyses indicated that PTL was an independent predictor for survival. O‐BAC conferred the worst prognosis then followed by A‐BAC, D‐BAC, and UAC. For non‐metastatic UAC or D‐BAC, partial cystectomy (with an en bloc resection of the urachus and umbilicus) is optimal for survival. However, the worse survival of non‐metastatic D‐BAC (compared with UAC) suggested different modalities, maybe more intensive surgery approaches, should be considered for D‐BAC. Conclusion This study illustrates that PTL of UAC and BAC was an independent predictor for survival. A‐BAC had comparable characters and prognosis with O‐BAC and should not be classified into and treated as UrC. For non‐metastatic disease, non‐metastatic D‐BAC may need more intensive modality., Anterior wall of bladder adenocarcinoma (A‐BAC) had comparable characters and prognosis with other sites of bladder adenocarcinoma, while dome adenocarcinoma of the bladder is similar to urachal adenocarcinoma arising from the urachus. A‐BAC should be classified into and treated as BAC, instead of urachal carcinoma.

BACKGROUND Management of the patients with urachal remnants (URs) has been under discussion for a long time. The traditional approach with surgical removal of all urachal remnants, has been changed to a more conservative, which is preferred by many surgeons, especially in asymptomatic patients. AIM The purpose of this study was to optimize the treatment of patients with URs, primarily for asymptomatic children. RESULTS Our previous screening study showed that real incidence of the URs in childhood is significantly higher than it was previously stated. Based on our data and the results of literature review, we propose an algorithm for the workup and treatment of children with URs. CONCLUSION We assume that the risk of developing complications (primarily, malignancy) was previously significantly overestimated. In this regard, we recommend conservative tactics in in most asymptomatic cases.

Introduction: Although laparoscopic urachal excision in children has been well reported, there are limited data on a robot-assisted surgery (RAS) approach. The hidden incision endoscopic surgery (H...

We describe our experience in 2 institutions handling bladder prolapse through a patent urachus (PU), together with a brief review of published literature. Case 1: A term neonate with congenital prolapsed bladder via PU. Ultrasound at 21 weeks gestation revealed a male fetus with a large midline pelvic cyst communicating with the bladder which disappeared on subsequent 27 weeks ultrasound. Case 2: A term female neonate with congenital prolapsed bladder via PU with no prenatal diagnosis. In both cases the bladder closure was undertaken during the newborns’ first days of life.

Persistent urachal anomalies are rare congenital lesions of the urinary tract. They result from the failed obliteration of the urachus and are classified according to persistent segment of the urachus.

ZusammenfassungDas Uroperitoneum ist eine typische Erkrankung des neugeborenen Fohlens. Durch einen kongenitalen oder erworbenen Defekt im Harntrakt kommt es zur Ansammlung von Urin in der Bauchhöhle. Männliche Tiere sind öfter betroffen als weibliche. Am häufigsten entwickelt sich ein Uroperitoneum durch eine Zusammenhangstrennung in der dorsalen Harnblasenwand. Die Harnblase ist in 73,1 %, der Urachus in 21,6 % und die Ureteren in 5,2 % der Fälle betroffen. Erkrankte Fohlen zeigen meist 2–5 Tage post natum typische klinische Symptome wie reduziertes Allgemeinbefinden, umfangsvermehrtes Abdomen, milde Koliksymptome und unphysiologisches Harnabsatzverhalten. Die sonografische Untersuchung in Verbindung mit der Abdominozentese gilt als Goldstandard der Diagnostik. Typische labordiagnostische Befunde sind Azotämie, metabolische Azidose und Elektrolytabweichungen, insbesondere Hyperkaliämie, Hyponatriämie und Hypochloridämie. Die chirurgische Versorgung des Defekts stellt die einzige adäquate Behandlung dar. Vor dem chirurgischen Eingriff sollten stets die metabolische Entgleisung und die Verschiebungen im Elektrolythaushalt korrigiert werden, da vor allem die Hyperkaliämie das Komplikationspotenzial der Anästhesie erhöht. Bei guter perioperativer Stabilisierung und einem Defekt an der Blase oder am Urachus ist die Prognose gut. Insgesamt werden 63,6 % der betroffenen Fohlen geheilt. Zu den häufigsten Komplikationen gehören Rezidive durch Nahtdehiszenz oder einen inkompletten Verschluss der Defekte.

Urachal remnants are thought to have a low prevalence. However, recent studies indicate a higher rate. The aim of this study was to evaluate the prevalence of urachal remnants in children referred for imaging by abdominal/urinary/suprapubic ultrasonography in one calendar year. Files of children who underwent abdominal/urinary/suprapubic ultrasonography in one calendar year were retrospectively reviewed. Data regarding children ≤17 years that underwent ultrasonography of the ventral abdominal wall while being assessed for various reasons were collected. Anomalies detected, age, gender, reason for ultrasonography request, and diagnosis of the urachal remnant were noted. All ultrasonography assessments were performed by a single pediatric radiologist in a single institution. There were 4836 patients in the study (1919 boys). Median age of the whole cohort was 7 years. A total of 10 patients were found to have urachal remnants, which included eight urachal cysts (three boys) and two urachal diverticula (one boy).Conclusion: The prevalence of urachal remnants in our cohort was nearly 2 in every 1000 children. More specifically, the prevalence of urachal cysts was one in 600. What is Known: • Urachal remnants were believed to be rare. • Recent studies indicated a higher incidence than previous reports. What is New: • This study shows that urachal remnant may be observed in one every 500 children that undergo ultrasonography of the abdomen for various reasons. • Parental counselling and management of urachal remnants should be planned accordingly.

Introduction: The urachus or median umbilical ligament is a fibrous cord originating from the allantoic canal’s involution. It extends from the bladder dome to the posterior umbilicus. A partial or a total defect of the urachus channel’s obliteration after the fifth month of gestation can be the origin of urachal abnormalities. A complication of symptomatic urachal anomalies occurs when the cyst fistulizes to adjacent viscera. We report the first case of a diverticulosis-related sigmoid-urachal-scrotal cyst in a 55-year-old patient. Case Report: A 55-year-old male visited the clinic with intermittent fever, lower abdominal pain, swelling in the groin and scrotal area. Abdominal examination revealed a diffuse tender in the lower abdomen and suprapubic area. Non-contrast abdominal CT imaging showed a cystic lesion with an air-fluid level and possibly debris positioned superiorly to the bladder at the abdominal wall. The sigmoid colon seemed attached to this cystic lesion. Air observed in the scrotum and subcutaneous. The damaged part of the sigmoid colon was repaired. Then the abscess was drained. Urachus was wholly resected and removed. After five days of follow-up, the patient was discharged without any problem. A severely inflamed urachus was found in pathology. Conclusion: Although it is rare and its symptoms are non-specific, the urachal abscess should be suspected if there is persistent fever and suprapubic pain, especially in patients with diverticula. It is recommended to remove it when the diagnosis is made, considering the complications that may occur.

El adenocarcinoma de uraco es una enfermedad neoplásica rara, con una incidencia de 1 por 5 millones de habitantes. Clínicamente se manifiesta con hematuria (73%), dolor abdominal (14%), disuria (13%), mucosuria (10%), síntomas irritativos (40%), masa palpable en la parte baja del abdomen (17%), bacteriuria (8%), flujo mucoso umbilical (2%). Presentamos el caso de paciente de 45 años, con diagnóstico de adenocarcinoma de uraco, que recibió múltiples tratamientos sin respuesta, realizándose, cirugía radical con resección en bloque de ombligo, uraco, peritoneo, fascia posterior del musculo recto del abdomen y cistectomía parcial, por abordaje laparoscópico, con excelentes resultados oncológicos y estéticos, con recuperación rápida, y sin complicaciones. El papel de la quimioterapia y radioterapia y su beneficio para el paciente aún no está claro. Con este caso queremos aportar con un nuevo caso a la literatura, además de poder mostrar que el manejo con mínima invasión puede ser adecuada en manos expertas, con resultados iguales a la cirugía abierta, con el beneficio ya conocido del abordaje laparoscópico.

Our objective was to evaluate the impact of 18F-FDG PET CT on the management of urachal adenocarcinoma (UrC-ADC). Methods: A retrospective analysis of patients with UrC-ADC from 2001 to 2019 at Memorial Sloan Kettering was performed. Mayo stage before 18F-FDG PET/CT, rate of detection of the primary malignancy and metastases on 18F-FDG PET/CT, Mayo stage after 18F-FDG PET/CT, and change in patient management were determined. Results: Of 21 patients with UrC-ADC before 18F-FDG PET/CT, Mayo staging was I/II in 8, III in 3, and IV in 10. 18F-FDG PET/CT detected previously unidentified metastases in 8 (38%) of 21 patients, resulting in upstaging of disease in 3 (14%) patients and a change in treatment in 4 (19%) patients. Conclusion:18F-FDG PET/CT has clinical utility in patients with UrC-ADC by identifying metastatic disease not appreciated on anatomic imaging, leading to changes in staging and patient management.

A vesicourachal remnant is the rarest presentation of the congenital urachal remnant anomalies, occurring approximately in 3% of those who have them. We discuss a case where a vesicourachal anomaly is discovered incidentally in a pediatric patient by ultrasound and subsequently confirmed by MRI. The urachus connects the dome of the bladder to the umbilical cord in fetal life. After birth, this structure is obliterated and becomes the median umbilical ligament. When complete obliteration does not occur, a urachal remnant is created.

Introducción. La patología umbilical es un tema frecuente en el ámbito pediátrico, la presentación clínica de una fístula umbilical hace pensar en dos patologías mencionadas en la literatura de manera independiente; la primera es la persistencia del conducto onfalomesentérico y la segunda es la persistencia del remanente del uraco producto del fracaso en el cierre de las estructuras embrionarias. Su presencia en adultos es infrecuente y no existen datos estadísticos acerca de su presentación conjunta en población pediátrica o adulta, solo algunos pocos reportes de caso. El diagnóstico se basa principalmente en la sospecha clínica, depende en gran manera del examen físico al evidenciar secreción a través del ombligo al realizar esfuerzos o maniobras de Valsalva. Objetivo. Mostrar un caso infrecuente de la presentación simultánea del conducto de uraco y onfalomesentérico en un paciente adulto. Reporte de caso. Paciente femenina de 24 años de edad con antecedentes de infecciones urinarias y celulitis periumbilicales a repetición. Se sospecha un conducto persistente onfalomesentérico por lo que es sometida a un procedimiento quirúrgico en el que se encontró incidentalmente la persistencia simultánea del conducto onfalomesentérico y persistencia del uraco. Discusión. La persistencia del conducto onfalomesentérico o la persistencia del uraco de forma individual es poco frecuente en adultos, y es aún más raro la persistencia simultánea de ambos conductos; la presencia simultánea de ambos conductos es reportada principalmente en menores de dos años. Conclusiones. La persistencia de estos conductos es rara en adultos y representa un reto diagnóstico para el clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826. Introduction. Umbilical pathology is a common topic in the pediatric sphere. The clinical presentation of an umbilical fistula leads to the consideration of two pathologies independently reported in literature. The first is a persistent vitelline duct and the second is a persistent urachal remnant as a result of the embryonic structures’ failure to close. They are uncommon in adults and there are no statistical data about their presentation together in the pediatric or adult population, only very few case reports. The diagnosis is mainly based on clinical suspicion. It largely depends on a physical examination noting secretion through the navel when straining or performing Valsalva maneuvers. Objective. Show an uncommon case of the simultaneous presentation of the urachus and vitelline ducts in an adult patient. Case report. Female patient aged 24 years with a background of repeated urinary tract infections and periumbilical cellulitis. A persistent vitelline duct is suspected. Therefore, the patient is subject to a surgical procedure in which the simultaneous persistence of the vitelline duct and the urachus was found incidentally. Discussion. The persistence of the vitelline duct or the persistence of the urachus individually is uncommon in adults, and the simultaneous persistence of both ducts is even rarer. The simultaneous presence of both ducts is reported mainly in infants aged under two years. Conclusions. The persistence of these ducts is rare in adults and poses a diagnostic challenge for clinicians. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826. Introdução. A patologia umbilical é um tópico frequente no cenário pediátrico; a apresentação clínica de uma fístula umbilical faz pensar em duas patologias mencionadas na literatura de forma independente; a primeira é a persistência do ducto onfalomesentérico e a segunda é a persistência do úraco como resultado da falha no fechamento das estruturas embrionárias. É pouco frequente sua presença em adultos e não há dados estatísticos sobre sua apresentação conjunta em população pediátrica nem adulta, apenas alguns poucos relatos de caso. O diagnóstico baseia-se principalmente na suspeita clínica, dependendo em grande parte do exame físico ao evidenciar uma secreção pelo umbigo quando realizar esforço ou manobra de Valsalva. Objetivo. Mostrar um caso infrequente de apresentação simultânea do úraco e ducto onfalomesentérico em um paciente adulto. Relato de caso. Paciente do sexo feminino, 24 anos, com histórico de infecções urinárias e celulite periumbilical recorrentes. Suspeita-se de um ducto onfalomesentérico persistente, portanto ela é submetida a um procedimento cirúrgico no qual encontrou-se a persistência do ducto onfalomesentérico e a persistência de úraco simultaneamente. Discussão. A persistência do ducto onfalomesentérico e a persistência de úraco individualmente é rara em adultos, e a persistência simultânea de ambos os ductos é ainda mais rara; esta presença simultânea é relatada principalmente em crianças menores de dois anos de idade. Conclusão. A persistência desses ductos é rara em adultos e representa um desafio diagnóstico para o profissional de saúde clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Background: Urachal carcinoma accounts for

Background Urachal anomalies (UAs) are rare in children; the most encountered are urachal cysts, urachal sinus, and urachal diverticulum. Other associated anomalies have been reported to include renal and abdominal wall defects. No skeletal anomalies have been reported to date. Case presentation We present a case of a 20-month-old female patient, who presented to our emergency department with a fever of 2 weeks duration associated with colicky abdominal pain, a tender abdomen, and an infraumbilical mass. The suspicion of urachal sinus abscess was confirmed by ultrasound. The patient was also found to have a single left kidney and multiple vertebral segmental anomalies on a full-body computed tomography scan. The patient underwent open surgical excision of the urachal abscess without complications on follow-up. Conclusion Urachal abscess is rare in children. Associated anomalies include renal and abdominal wall defects. To our knowledge and based on our meticulous search through the literature, this is the first case to report a combination of renal and skeletal findings in a child. Whenever a urachal remnant is found in a patient, a radiological investigation should be made to rule out associated anomalies.

Purpose The identification of urachal remnants is occurring more in infancy. Despite evidence that nonoperative management is effective, operative management remains common and has a high complication rate. We sought to determine if the complication rate after urachal resection is associated with age. Methods Patients undergoing urachal remnant resection were identified from ACS NSQIP Pediatric from 2013 to 2017. Exclusion criteria included emergent operations, contaminated wounds, and any additional procedures. Patients were compared based on complication rates, need for reoperation or readmission, and length of stay. Results A complication occurred in 16 of 476 patients (3.3%), 6 (1.3%) had reoperation, and 11 (2.3%) were readmitted. The median age for patients requiring reoperation was lower (0.1 years) than those not (1.3 years; p = 0.004). The median age of those readmitted was lower (0.4 years) than those not (1.4 years, p = 0.03), and a weak trend of longer length of stay in younger patients was identified (ρ = − 0.16, p Conclusions Operative management of younger patients resulted in greater risk of reoperation, readmission, and longer length of stay. Given that nonoperative management is effective, it may be of benefit to delay resection of urachal remnants to after 1 year of age. Study type Treatment study. Level of evidence Level III.

BACKGROUND Diseases affecting the internal umbilical remnant are common in foals. Ultrasound is used to diagnose abnormalities of these structures, and to monitor treatment. However, little is known about the progression of normal internal umbilical remnant regression. OBJECTIVES To document normal regression of the umbilical remnant in foals over the first 6 weeks of life. STUDY DESIGN Prospective, longitudinal cohort study. METHODS Weekly ultrasound examinations were performed beginning at 1 day of age in 34 healthy Standardbred foals. The umbilical vein was measured in cross section just cranial to the external umbilicus, at the level of the liver and midway between these points. The umbilical arteries were measured in cross section just caudal to the external umbilicus, at the apex of the bladder and at the midpoint of the bladder. The urachus was imaged longitudinally as it exited the bladder. Reduction in size over time was evaluated as percentage change in diameter. RESULTS Structure diameter decreased linearly over time. The largest measurements were at 24 hours of age with a median umbilical vein diameter of 0.83 cm (IQR 0.77-1.02 cm), median umbilical artery diameter of 0.61 cm (IQR 0.56-0.70 cm) and median urachal diameter of 1.07 cm (IQR 1.02-1.14 cm). There was a significant reduction in diameter for all structures (16.0%-21.9%; corrected P

An umbilical cord hernia (UCH) is a form of abdominal wall defect, affecting 6 out of every 10,000 newborns. The persistence of urachus is an embryonic remnant that connects the bladder to the abdominal wall at the level of the umbilicus, being yet more uncommon. We reviewed the literature, searching in PubMed, under the terms “Hernia of umbilical cord”, “Congenital hernia of cord” and “Persistent Urachus”. Only a few similar cases of both pathologies associated described were found. Our main objective is to highlight the distinct clinical features, embryogenesis, prognosis and associated anomalies of two infrequent embryopathies. And to describe a infrequent case of both abnormalities presenting simultaneously. UCH are often misdiagnosed with other abdominal wall deffects, such as omphalocele, umbilical hernias, gastroschisis and umbilical cord cysts. The normal cord insertion, adequate muscle development of the abdominal wall and a wall defect less than 5cm is what differentiates it from an omphalocele. UCH has a low morbidity overall, as it is not associated with other anomalies. The most frequently observed urachal malformations are the persistence of a urachus and urachal cyst. The prenatal diagnosis of patent urachus is made by ultrasound or magnetic resonance, being easily mistaken with abdominal wall defects, confirming the diagnosis with an ultrasound at birth. The persistence of urachus may resolve spontaneously, if not, surgical resolution is recommended. Similar to a UCH, a patent urachus shows little association with other malformations. It is important to know the clinical presentation and the diagnostic perinatal methods employed for appropriate management and favorable results for both pathologies. This relies on knowing when to suspect possible associated anomalies and when complementary studies might be needed. It is also important to be aware that there is the possibility of a UCH and a patent urachus existing simultaneously.

Urachal epithelial neoplasms are rare tumors that arise from the vestiges of the urachus. Mucinous cystadenomas are considered as a benign glandular tumors of the urachus. Cystadenomas are commonly found in the ovary, appendix, and pancreas. Mucinous cystadenomas of the urachus are extremely rare in the urachus, and only nine cases reported so far. We reported the 10th case of Mucinous cystadenomas of the urachus detected incidentally at the time of diagnostic laparoscopy for investigation of genitourinary tuberculosis.

Biopsies from the urinary bladder are challenging and it may be difficult to differentiate normal from benign or reactive processes, and even from low-grade neoplastic processes. This chapter addresses these common problems by profiling immunohistochemical stains that change their patterns of expression from that of normal urothelium, including both the cellular layers and cellular compartments in which markers are expressed. Morphologic patterns of urothelial carcinoma that cause diagnostic dilemmas are also included, such as glandular lesions of both primary and metastatic origin, and lesions with variant histologic growth patterns. Staining patterns of urachal neoplasms and their differential diagnoses are addressed. Nephrogenic adenomas of the urothelial tract and their mimics are covered. Although uncommon, the differential diagnosis of spindle cell lesions is also addressed.

Persistent urachal anomalies are rare congenital lesions of the urinary tract. They result from the failed obliteration of the urachus and are classified according to persistent segment of the urachus.

Metastasis to the ovary from a bladder primary is extremely rare with limited case reports. The most common primary sites arise from stomach, colon or renal origin and usually occur from 40 years of age onwards. We report a case of an 18-year old woman with a right sided Krukenberg tumour from a bladder primary. This patient is much younger than any other case report of Krukenberg tumour and reiterates the need for early excision of urachal masses in all age groups.

PurposeTo explore the clinical and radiological differences between urachal carcinoma and urachal infection.MethodsClinical and imaging information for 13 cases of urachal carcinoma and 14 cases of urachal infection confirmed by pathology were retrospectively analyzed. The size, location, shape, margin, lesion composition, calcification, T1 and T2 signal intensity, peripheral lymph nodes, degree of enhancement, adjacent bladder wall, and apparent diffusion coefficient (ADC) value were examined in both groups, and distinguish features were determined. The student t-test or Mann-Whitney U test was used for quantitative data, and Fisher’s exact test was used for qualitative data. Kappa coefficient consistency test was used to evaluate the interobserver agreement.ResultsSex, hematuria, abdominal pain, calcification, and thickening of adjacent bladder wall can distinguish between urachal carcinoma and urachal infection (p < 0.05). There were no statistical differences in age (p = 0.076), size (p = 0.797), location (p = 0.440), shape (p = 0.449), margin (p = 0.449), lesion composition (p = 0.459), T1 signal intensity (p = 0.196), T2 signal intensity (p = 0.555), peripheral lymph nodes (p = 0.236), degree of enhancements (p = 0.184) and ADC value (p = 0.780) between two groups.ConclusionThe following clinical and imaging features help distinguish urachal carcinoma from urachal infection: sex, hematuria, abdominal pain, calcification, and thickening of the adjacent bladder wall.

INTRODUCTION AND OBJECTIVE:Peritoneal vaginoplasty has been reported for congenital and primary gender-affirming cases, but few have reported its use to treat post-op neovaginal shortening after pe...

Simultaneous presentation of omphalocele, patent urachus, and umbilical cyst is very rare. There is wide range of differential diagnosis for umbilical cyst. Accurate assessment of umbilical cysts is important to evaluate other abnormalities.

Urachal carcinoma is a rare bladder malignance. This study presents a case of an elderly patient with urachal carcinoma who was found to have pulmonary metastases 1 year after 5 recurrent resections. The patient was treated with up to 7 different chemotherapy regimens, including a VEGF monoclonal antibody and anti-PD-1 antibody. This is the first report of PD-1 antibody being used in patients with urachus, although the disease progressed after only four cycles of the application. The patient’s disease was controlled by the FOLFIRI combined with the VEGF monoclonal antibody regimen. The most prominent issues at present are the difficulty of obtaining drugs for rare cancers and the lack of late-stage clinical trials to guide therapeutic decisions.

Urachal villous adenoma is a rare entity. We aimed to share a case of a giant villous adenoma that was treated surgically. Surgery was uneventful and flow up was normal.

Urachal anomalies are infrequent in the adult population and may represent a diagnostic challenge. Few cases of urachal sinuses are reported and are usually asymptomatic unless a complication occurs, most likely infectious. Infected urachal sinus' clinical manifestations are a purulent umbilical discharge, abdominal pain, and a periumbilical mass. We report the case of a late presentation of an infected urachal sinus in a male adult. Clinical and imaging features allowed accurate diagnosis. Antibiotic therapy was followed by the urachal remnant’s surgical excision. The postoperative course was uneventful. Histological examination revealed no signs of malignancy.

The umbilicus is a potential access-point for pathogens in equine foal, causing umbilical infections and potentially life-threating illness. Early diagnosis based on ultrasonographic appearance and measurement is crucial to avoid severe complications and promptly implement appropriate therapy. This study ultrasonographically evaluates the umbilical remnants of donkey foals, in the first week of life. Fifteen healthy donkey foals were included in the study. The umbilical vein, arteries and urachus ultrasounds were performed at 24 h, 3 and 7 days of life, using a portable ultrasound machine and a 5–7.5 MHz multifrequency linear probe. The Kruskal–Wallis test and Dunn’s multiple comparisons test were applied to verify differences in relation to time for all the umbilical remnants measured. Statistical significance was set at p &lt, 0.05. No statistical differences were observed in relation to time regarding umbilical remnant measurements. A correlation was found between body weight and the left artery at T0. The regression of the umbilical remnant during the first week of life was slower compared with what was reported in equine foals but was comparable with the results on calves. Thus, the different regression timing needs be considered when evaluating donkey foals with umbilical remnant diseases within the first week of life.

Background Urachal cysts are an uncommon congenital abnormality that result from the incomplete obliteration of the urachus [1] . Typical presentation is in childhood, and previous pediatric autopsy studies have shown an incidence to be 1 in 5000 cases [2] . These urachal cysts are frequently asymptomatic, however, some patients can present with symptoms of lower abdominal pain, features of urinary tract infection, a painful abdominal lump, and/ or hematuria [3] . Differential diagnosis for an uninfected urachal cyst includes a bladder diverticulum, vitelline cyst, mesenteric cyst, Meckel diverticulum, and an umbilical hernia. Bladder adenocarcinoma should be considered as a differential diagnosis for an infected urachal cyst. Objective To share the surgical case of a robot-assisted excision of a calcified urachal cyst. Methods/materials We present the case of a 50-year-old previously healthy female who presented with intermittent gross hematuria for 1 year. CT Urogram demonstrated a urachal sinus cystic and calcified mass. Cystoscopy performed in clinic showed no obvious connection from the bladder to the urachus. The decision was made to proceed with a robot-assisted excision of the calcified urachal cyst. Results Intra-operatively, there was an obvious urachal cyst identified several centimeters superior to the decompressed bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect was closed in two layers using 3–0 V-lock. The bladder was filled to demonstrate there was no leak. The urachal cyst was removed without complication. Conclusion Urachal cysts are a rare anomaly with a heterogenous clinical presentation. Robot-assisted surgery provides a minimally invasive technique for excision of a urachal cyst when indicated.

The urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. They are very rarely seen in adults because the urachus is normally obliterated in early infancy. Clinical presentation is non-specific; therefore, a high index of suspicion is required to make the diagnosis. When it is diagnosed, surgical excision is advised due to the risk of malignant transformation. We describe the case of a 26-year-old male who presented with a small swelling of the umbilicus and purulent umbilical discharge. The diagnosis of an infected urachal cyst was confirmed on ultrasonography abdomen and contrast-enhanced computed tomography abdomen. He was treated initially with broad-spectrum antibiotics and then by surgical excision of the cyst and fibrous tract. Histology of the excised specimen showed chronic inflammation with no evidence of malignancy. Post-operative recovery was uneventful.

Urachal anomalies are classified into four types depending on the level of persistence of the embryonic urachal remnants between the urinary bladder and the umbilicus: patent urachus, umbilical-urachal sinus, urachal cyst, and vesico-urachal diverticulum. Due to the increasing use of cross-sectional imaging, urachal anomalies are frequently detected as incidental findings. Imaging plays a pivotal role in the initial diagnosis, evaluation of complications, treatment follow-up, and long-term surveillance of patients with urachal anomalies. Different urachal anomalies demonstrate characteristic imaging features that aid in a timely diagnosis and guide treatment. A patent urachus is visualized as an elongated tubular structure between the umbilicus and the urinary bladder. While umbilical-urachal sinus appears as focal dilatation at the umbilical end of the urachal remnant, the vesico-urachal diverticulum presents as a focal outpouching of the urinary bladder at anterosuperior aspect. Urachal cysts are identified as midline fluid-filled sacs most frequently located near the dome of the urinary bladder. Untreated urachal anomalies could progress into potential complications, including infection and malignancy. Knowledge regarding imaging features of urachal anomalies helps in timely diagnosis, treatment, follow-up, and early detection of complications.

Introduction: Urachal remnants are relatively rare. Generally, urachal remnants are detected in young people, and the removed specimen is small, comprising a good indication for laparoscopic surgery. Laparoendoscopic single-site surgery (LESS) for urachal remnants is considered to be safe and result in an excellent cosmetic outcome. Therefore, we report our single-center experience with LESS for urachal remnants. Methods: We retrospectively reviewed 30 patients with urachal remnants who underwent LESS from January 2011 to December 2017. The patients’ characteristics, surgical data, postoperative pain, and cosmetic assessment results were retrospectively collected and analyzed. Results: Mean total operative time was 151 min, mean pneumoperitoneal surgery time was 83 min, and mean estimated blood loss was 5.0 mL. All patients were started on an oral diet and began ambulating on postoperative day 1. Mean hospital stay was 5.5 days. LESS was completed successfully in all patients, with no conversion to conventional or open surgery. Conclusions: LESS is a viable option for the surgical treatment of urachal remnants. This technique may result in less pain than conventional techniques. Further accumulation of surgical outcomes (especially regarding safety and cosmesis) is required for LESS to become an established treatment for urachal remnants.

Urachal cyst is a rare condition that is typically asymptomatic and will often have symptomatology that is misdiagnosed or missed. A urachal cyst occurs in 1 out of 5000 live-births, but is only clinically relevant in 1 out of 150,000 of the population often as an incidental finding. The urachus is the embryological remnant of the allantois, which connects the apex of the bladder to the umbilicus, and usually fully obliterates to become the median umbilical ligament.Urachal defects are uncommon and cysts are usually asymptomatic until infection results. An infected cyst may present mimicking a wide range of intra-abdominal and pelvic disorders, and accurate diagnosis is often delayed. Children may present with umbilical discharge; adults often have hematuria. Computed tomography (CT) and ultrasound are ideally suited for demonstrating urachal remnant diseases; however, infected urachal cysts commonly display increased echogenicity with ultrasoundsography and thick-walled cystic or mixed attenuation with CT. Drainage and excision of the urachal remnant is the definitive treatment. Keywords: Pediatric radiology, Diagnostic radiology, Ultrasound, Urology

Purpose The purpose of this study was to evaluate trends in management of urachal anomalies at our institution and the safety of nonoperative care. Methods Based on our experience managing urachal remnants from 2000 to 2010 (reported in 2012), we adopted a more conservative approach, including preoperative antibiotic use, refraining from using voiding cystourethrograms (VCUG), postponing surgery until at least six months of age, and considering nonoperative management. A retrospective analysis of urachal anomaly cases was conducted (2011–2016) to assess trends in practice. Charts indicating anomalies of the urachus were pulled and trends in management (nonoperative versus surgical treatment), VCUG and antibiotic use, and outcomes were reviewed. Results Data from 2000–2010 and 2013–2016 were compared. Our findings indicate care has shifted towards nonoperative management. A smaller proportion of patients from 2013–2016 was treated surgically compared to 2000–2010. Patients receiving nonoperative treatment exhibited lower rates of complication relative to surgically managed cases. VCUGs were eliminated as a diagnostic tool for evaluating urachal anomalies. Prophylactic preoperative antibiotic use was standardized. No patients with a known urachal remnant presented later with an abscess or sepsis. Conclusions We find that a shift towards nonoperative treatment of urachal anomalies did not adversely affect overall outcomes. We recommend observing minimally symptomatic patients, especially those under six months old. Study type Performance improvement. Level of evidence Level IV.

Urachal cancer is a rare but aggressive disease. In addition to the non-glandular tumors, non-cystic urachal adenocarcinomas are nowadays distinguished from the primary cystic variant. (Immunohistochemical) markers are only of minor differential diagnostic value and, therefore, the diagnosis is primarily established in a multidisciplinary approach. The non-cystic variant accounts for the majority of cases (83%), is more common in men (63%), shows a median age at diagnosis of 51 years and has a 5-year survival rate of about 50%. In organ-confined disease, usually a partial cystectomy of the tumor in the bladder dome, including the median umbilical ligament and umbilicus, is performed. In advanced stages, systemic therapy is needed while 5‑fuorouracil (5-FU) containing regimes have been shown to be more effective. Due to the rarity of the tumor, targeted therapy approaches based on a biological rationale are becoming increasingly relevant. As molecular data are still sparse, we compiled and analyzed the largest urachal cancer cohort to date. In 31% of the cases, MAPK-/PI3K signaling pathway alterations were detected (especially in K-/NRAS) with implications for anti-EGFR therapy approaches. Further potentially therapeutic alterations were detected in FGFR1, MET, PDGFRA, and erbB2/HER2. Additionally, PD-L1 tumor cell expression (clone: 22C3) was demonstrated in 16% of cases, therefore making anti-PD-1/PD-L1 immuno-oncological approaches worth considering despite the absence of mismatch repair deficiency (MMR-d) and/or high microsatellite instability (MSI-h). Finally, urachal adenocarcinomas seem to be a distinct entity on the molecular level with closer resemblance to colorectal adenocarcinomas than to urothelial carcinomas.

Introduction Urachus adenocarcinoma is an extremely rare malignant tumor characterized by its insidious evolution responsible for the delay in diagnosis. Several scientific works have tried to study the indication of adjuvant treatment, therefore the prognosis is still poor. Presentation of case We report the case of a 50-year-old patient with no pathological history who consulted for an episode of intermittent urinary mucosal secretion aggravated by the appearance of macroscopic hematuria. Without other associated clinical signs. Imaging examinations revealed a mass at the expense of the upper wall of the bladder. The cystoscopy allowed us to visualize the mass and the biopsy. Histological study revealed an adenocarcinoma of urachus. The patient underwent surgical exeresis and adjuvant chemotherapy. The evolution was marked by a deterioration of the general condition despite adequate management. Discussion Due to its topography, urachus cancer usually manifests as a bladder tumor, exceptionally as much as an anterior umbilical or extraperitoneal tumor. Few studies have been done on this neoplasm; however surgery still has a primary place in therapeutic management. Conclusion The scarcity of cases of urachus cancer makes the publications scarce and the lack of multicenter clinical and randomized trials explains the disagreement about adjuvant treatments., Highlights • Urachus cancer is a rare malignant tumor. • The tomodensitometry is the reference examination which makes it possible to think of the diagnosis in front of a mass of urachus. • Surgery remains the gold standard for therapeutic management. • The prognosis is pejorative because of the aggressiveness of the tumor of the delayed diagnosis.

Urachal adenocarcinoma, the third most common histopathological type of non-urothelial bladder cancer, is often aggressive, presenting in advanced stages. Increased understanding of the embryologic origin of the tumor with concurrent advances in surgical technique have allowed partial cystectomy to become the gold standard of surgical treatment. However, the benefit of en bloc umbilectomy remains questionable. Here we present the diagnosis and management of 67- year old patient diagnosed with mucinous cystadenocarcinoma of the urachus treated with umbilical-sparing robotic partial cystectomy. We also provide a review of the existing literature on this rare tumor and its management.

Surgical intervention for umbilical diseases in calves, when indicated, is a complementary and indispensable therapeutic resource for the treatment of umbilical conditions and is commonly performed using celiotomy. However, laparoscopy has demonstrated feasibility in many diagnostic and therapeutic procedures. The aim of this study was to assess the feasibility of the techniques and the surgical time of laparoscopy and celiotomy used in intra-abdominal resection of the umbilical vein and urachus of bovine fetuses (cadavers). Resection of the umbilical vein and urachus using laparoscopy and celiotomy was performed in 26 anatomical specimens (bovine fetuses obtained from an official slaughterhouse). Resection of umbilical structures was feasible with both techniques, but shorter surgical time and minimal tissue damage were achieved using laparoscopy. Laparoscopy requires specialized training and appropriate instruments and is an important tool for diagnostic and therapeutic exploration of the umbilical structures, liver, bladder, and associated/adjacent structures.