Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and Management of Urachal Anomalies in Children

  • Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nix JT, Menville JG, Albert M, Wendt DL. Congenital patent urachus. J Urol. 1958;79:264–73.

    CAS  PubMed  Google Scholar 

  2. Blichert-Toft M, Nielsen OV. Congenital patient urachus and acquired variants. Diagnosis and treatment. Review of the literature and report of five cases. Acta Chir Scand. 1971;137:807–14.

    CAS  PubMed  Google Scholar 

  3. Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics. 2001;108:493–4.

    Article  CAS  PubMed  Google Scholar 

  4. Begg RC. The Urachus: its anatomy, histology and development. J Anat. 1930;64:170–83.

    PubMed Central  CAS  PubMed  Google Scholar 

  5. Mahoney P, Ennis D. Congenital patent urachus. N Engl J Med. 1936;215:193–202.

    Article  Google Scholar 

  6. Gleason JM, Bowlin PR, Bagli DJ, Lorenzo AJ, Hassouna T, Koyle MA, et al. A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol. 2015;193:632–6. First and only study that attempts to correlate the incidence of congenital urachal anomalies in children and the development of urachal adenocarcinoma in adults.

    Article  PubMed  Google Scholar 

  7. Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediatr Surg. 2003;38:1203–7.

    Article  CAS  PubMed  Google Scholar 

  8. Fox JA, McGee SM, Routh JC, Granberg CF, Ashley RA, Hutcheson JC, et al. Vesicoureteral reflux in children with urachal anomalies. J Pediatr Urol. 2011;7:632–5. Study showing the highest recorded association between urachal anomalies and vesicoureteral reflux which also draws into question the clinical significance such asymptomatic vesicoureteral reflux may play.

    Article  PubMed  Google Scholar 

  9. Holten I, Lomas F, Mouratidis B, Malecky G, Simpson E. The ultrasonic diagnosis of urachal anomalies. Australas Radiol. 1996;40:2–5.

    Article  CAS  PubMed  Google Scholar 

  10. Mesrobian HGO, Zacharias A, Balcom AH, Cohen RD. Ten years of experience with isolated urachal anomalies in children. J Urol. 1997;158:1316–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cilento BG, Bauer SB, Retik AB, Peters CA, Atala A. Urachal anomalies: defining the best diagnostic modality. Urology. 1998;52:120–2.

    Article  PubMed  Google Scholar 

  12. Yiee JH, Garcia N, Baker LA, Barber R, Snodgrass WT, Wilcox DT. A diagnostic algorithm for urachal anomalies. J Pediatr Urol. 2007;3:500–4.

    Article  PubMed  Google Scholar 

  13. Huang C-S, Luo C-C, Chao H-C, Chen H-M, Chu S-M. Urachal anomalies in children: experience at one institution. Chang Gung Med J. 2003;26:412–6.

    PubMed  Google Scholar 

  14. Choi YJ, Kim JM, Ahn SY, Oh J-TT, Han SW, Lee JS. Urachal anomalies in children: a single center experience. Yonsei Med J. 2006;47:782–6.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Rich RH, Hardy BE, Filler RM. Surgery for anomalies of the urachus. J Pediatr Surg. 1983;18:370–2.

    Article  CAS  PubMed  Google Scholar 

  16. Naiditch JA, Radhakrishnan J, Chin AC. Current diagnosis and management of urachal remnants. J Pediatr Surg. 2013;48:2148–52. Elsevier Inc.

    Article  PubMed  Google Scholar 

  17. Nogueras-Ocaña M, Rodríguez-Belmonte R, Uberos-Fernández J, Jiménez-Pacheco A, Merino-Salas S, Zuluaga-Gómez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol. 2014;10:522–6.

    Article  PubMed  Google Scholar 

  18. Ashley RA, Inman BA, Routh JC, Rohlinger AL, Husmann DA, Kramer SA. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol. 2007;178:1615–8.

    Article  PubMed  Google Scholar 

  19. Galati V, Donovan B, Ramji F, Campbell J, Kropp BP, Frimberger D. Management of urachal remnants in early childhood. J Urol. 2008;180:1824–7.

    Article  PubMed  Google Scholar 

  20. Frimberger DC, Kropp BP. Bladder anomalies in children. Tenth Edit. Campbell-Walsh Urol. Philadelphia: Elsevier Inc.; 1995.

    Google Scholar 

  21. Steck WD, Helwig EB. Umbilical granulomas, pilonidal disease, and the urachus. Surg Gynecol Obstet. 1965;120:1043–57.

    CAS  PubMed  Google Scholar 

  22. Berman SM, Tolia BM, Laor E, Reid RE, Schweizerhof SP, Freed SZ. Urachal remnants in adults. Urology. 1988;31:17–21.

    Article  CAS  PubMed  Google Scholar 

  23. Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001;21:451–61.

    Article  CAS  PubMed  Google Scholar 

  24. Blichert-Toft M, Nielsen OV. Diseases of the urachus simulating intra-abdominal disorders. Am J Surg. 1971;122:123–8.

    Article  CAS  PubMed  Google Scholar 

  25. Metwalli ZA, Guillerman RP, Mehollin-Ray AR, Schlesinger AE. Imaging features of intravesical urachal cysts in children. Pediatr Radiol. 2013;43:978–82. First study to describe a previously unclassified form of urachal anomaly.

    Article  PubMed  Google Scholar 

  26. McCollum MO, Macneily AE, Blair GK. Surgical implications of urachal remnants: presentation and management. J Pediatr Surg. 2003;38:798–803.

    Article  CAS  PubMed  Google Scholar 

  27. Guarnaccia SP, Mullins TL, Sant GR. Infected urachal cysts. Urology. 1990;36:61–5.

    Article  CAS  PubMed  Google Scholar 

  28. MacNeily AE, Koleilat N, Kiruluta HG, Homsy YL. Urachal abscesses: protean manifestations, their recognition, and management. Urology. 1992;40:530–5.

    Article  CAS  PubMed  Google Scholar 

  29. Giuliani S, Vendryes C, Malhotra A, Shaul DB, Anselmo DM. Prune belly syndrome associated with cloacal anomaly, patent urachal remnant, and omphalocele in a female infant. J Pediatr Surg. 2010;45:e39–42.

    Article  PubMed  Google Scholar 

  30. Lane V. Congenital patent urachus associated with complete (hypospadiac( duplication of the urethra and solitary crossed renal ectopia. J Urol. 1982;127:990–1.

    CAS  PubMed  Google Scholar 

  31. Herbst WP. Patent urachus. South Med J. 1937;30:711.

    Article  Google Scholar 

  32. Schreck WR, Campbell WA. The relation of bladder outlet obstruction to urinary-umbilical fistula. J Urol. 1972;108:641–3.

    CAS  PubMed  Google Scholar 

  33. Blichert-Toft M, Koch F, Nielsen OV. Anatomic variants of the urachus related to clinical appearance and surgical treatment of urachal lesions. Surg Gynecol Obstet. 1973;137:51–4.

    CAS  PubMed  Google Scholar 

  34. Schneck FX. Commentary to “vesicoureteral reflux in children with urachal anomalies”. J Pediatr Urol. 2011;7:636.

    Article  PubMed  Google Scholar 

  35. Little DC, Shah SR, St Peter SD, Calkins CM, Murphy JP, Gatti JM, et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg. 2005;40:1874–6.

    Article  PubMed  Google Scholar 

  36. Yohannes P, Bruno T, Pathan M, Baltaro R. Laparoscopic radical excision of urachal sinus. J Endourol. 2003;17:475–9.

    Article  PubMed  Google Scholar 

  37. Sheldon CA, Clayman RV, Gonzalez R, Williams RD, Fraley EE. Malignant urachal lesions. J Urol. 1984;131:1–8.

    CAS  PubMed  Google Scholar 

  38. Cuda SP, Vanasupa BP, Sutherland RS. Nonoperative management of a patent urachus. Urology. 2005;66:1320.

    Article  PubMed  Google Scholar 

  39. Upadhyay V, Kukkady A. Urachal remnants: an enigma. Eur J Pediatr Surg. 2003;13:372–6.

    Article  CAS  PubMed  Google Scholar 

  40. Pinthus JH, Haddad R, Trachtenberg J, Holowaty E, Bowler J, Herzenberg AM, et al. Population based survival data on urachal tumors. J Urol. 2006;175:2042–7.

    Article  PubMed  Google Scholar 

  41. Lipskar AM, Glick RD, Rosen NG, Layliev J, Hong AR, Dolgin SE, et al. Nonoperative management of symptomatic urachal anomalies. J Pediatr Surg. 2010;45:1016–9. Elsevier Inc.

    Article  PubMed  Google Scholar 

  42. Copp HL, Wong IY, Krishnan C, Malhotra S, Kennedy WA. Clinical presentation and urachal remnant pathology: implications for treatment. J Urol. 2009;182:1921–4. Elsevier Inc.

    Article  PubMed  Google Scholar 

  43. Zieger B, Sokol B, Rohrschneider WK, Darge K, Tröger J. Sonomorphology and involution of the normal urachus in asymptomatic newborns. Pediatr Radiol. 1998;28:156–61.

    Article  CAS  PubMed  Google Scholar 

  44. Newman BM, Karp MP, Jewett TC, Cooney DR. Advances in the management of infected urachal cysts. J Pediatr Surg. 1986;21:1051–4.

    Article  CAS  PubMed  Google Scholar 

  45. Bertozzi M, Riccioni S, Appignani A. Laparoscopic treatment of symptomatic urachal remnants in children. J Endourol. 2014;28:1091–6.

    Article  PubMed  Google Scholar 

  46. Redmond HP, Ahmed SM, Watson RG, Hegarty J. Laparoscopic excision of a patent urachus. Surg Laparosc Endosc. 1994;4:384–5.

    Article  CAS  PubMed  Google Scholar 

  47. Bertozzi M, Nardi N, Prestipino M, Magrini E, Appignani A. Minimally invasive removal of urachal remnants in childhood. Pediatr Med Chir. 2009;31:265–8.

    PubMed  Google Scholar 

  48. Pesce C, Costa L, Musi L, Campobasso P, Zimbardo L. Relevance of infection in children with urachal cysts. Eur Urol. 2000;38:457–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Hans Arora and Jeffrey Donohoe declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA

    Hans Arora & Jeffrey Donohoe

Authors
  1. Hans Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Donohoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans Arora.

Additional information

This article is part of the Topical Collection on Pediatric Bladder Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arora, H., Donohoe, J. Diagnosis and Management of Urachal Anomalies in Children. Curr Bladder Dysfunct Rep 10, 256–263 (2015). https://doi.org/10.1007/s11884-015-0310-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-015-0310-y

Keywords

Search

Navigation