Urology: Urachal Anomalies

Urachal Anomalies

Basics

  • Cause:
    • Failure of Urachal Canal Obliteration
    • Non-Descent of the Bladder
  • May be Confused with a Persistent Omphalomesenteric Duct
  • Potential for Malignant Transformation as an Adult

Types

  • Patent Urachus – Bladder Connection to Umbilicus
  • Urachal Cyst – Cyst with No Communication to the Bladder or Umbilicus
  • Urachal Sinus – Obliteration Only at the Level of the Bladder with Persistent Sinus Communicating with the Umbilicus
  • Urachal Diverticulum – Almost Entire Obliteration Except at the Bladder Apex

Urachal Anomalies: (a) Patent Urachus, (b) Urachal Sinus, (c) Urachal Diverticulum, (d) Urachal Cyst 1

Presentation

  • Fluid Drainage from Umbilicus
  • Bladder Outlet Obstruction
  • Infection & Abscess

Diagnosis

  • Primary Diagnosis: Imaging (US, MRI or Retrograde Fistulogram)
  • Fluid Cr May Be Elevated if Connected to Bladder

Treatment

  • Asymptomatic: Nothing
    • May Consider Resection Due to Risk for CA as an Adult
  • Symptomatic:
    • Abscess: Incision & Drainage
    • No Active Infection: Surgical Resection (Open or Laparoscopic)
      • Resect Sinus & Close Bladder Defect

References

  1. Tazi F, Ahsaini M, Khalouk A, Mellas S, Stuurman-Wieringa RE, Elfassi MJ, Farih MH. Abscess of urachal remnants presenting with acute abdomen: a case series. J Med Case Rep. 2012 Jul 30;6:226. (License: CC BY-2.0)