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Sghaier A, Lamloum E, Debaibi M, Sridi A, Chouchene A. Surgical management of benign noninfected urachal cysts in adult patients: two case reports. J Med Case Rep 2023; 17:214. [PMID: 37221572 DOI: 10.1186/s13256-023-03944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Abnormalities of the urachus include the patent urachus, cysts, sinus, and fistula. Each of these entities represents a failure of complete obliteration of the urachus. Contrary to other urachus anomalies, urachal cysts are usually small and silent unless they are infected. The diagnosis is often made during childhood. A benign noninfected urachal cyst discovered in adulthood is a rare condition. CASE PRESENTATION Herein we report two cases of benign noninfected urachal cysts in adults. The first case is a 26-year-old Tunisian white man who presented with complaints of clear fluid draining from the base of the umbilicus evolving for a week, with no other associated symptoms. The other case was 27-year-old Tunisian white woman who was referred to the surgery department with a history of intermittent draining of clear fluid from the umbilicus. The two cases had laparoscopic resection of urachus cysts. DISCUSSION Laparoscopy represents a good alternative for the management of persistent or infected urachus, especially when this is suspected, despite a lack of radiological evidence. Laparoscopy in the management of urachal cysts is safe, effective, and offers good cosmesis, with all the advantages of a minimally invasive approach. CONCLUSION Managing persistent and symptomatic urachal anomalies requires a wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. A laparoscopic approach offers excellent outcomes, and is recommended to treat these abnormalities.
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Affiliation(s)
- Asma Sghaier
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Eya Lamloum
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mehdi Debaibi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Azza Sridi
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Adnene Chouchene
- Hospital of The Forces and The Security of Interior La Marsa Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Hoshi A, Chihara I, Shiga M, Nitta S, Nagumo Y, Sakka S, Kojo K, Ikeda A, Yoshino T, Kimura T, Kawahara T, Kandori S, Negoro H, Nishiyama H. Laparoendoscopic single-site surgery for urachal remnant with extraperitoneal approach through a suprapubic port. Asian J Endosc Surg 2022; 15:569-576. [PMID: 35307970 PMCID: PMC9313573 DOI: 10.1111/ases.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION No standard procedure has been established for laparoendoscopic single-site surgery for urachal remnants (LESS-U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single-site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS). METHODS Fifty-five patients (median age, 27 years; range, 15-69 years) who underwent LESS-U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS-U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self-administered questionnaires (body image and photo-series questionnaire). RESULTS spLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo-series questionnaires. No patient developed major complications; there was no recurrence in either group. CONCLUSIONS spLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.
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Affiliation(s)
- Akio Hoshi
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Ichiro Chihara
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Masanobu Shiga
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Satoshi Nitta
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Shotaro Sakka
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Kosuke Kojo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Atsushi Ikeda
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Takayuki Yoshino
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Tomokazu Kimura
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Takashi Kawahara
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Shuya Kandori
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hiromitsu Negoro
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
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Isaev Y, Bertozzi M. Laparoscopic surgery of urachal remnants in children: 3-center experience and comparison to an open approach. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Since the first description by Trondsen in 1993, laparoscopy has become the preferred method of surgery of urachal remnants in children. Some authors call it the “gold standard.” Nonetheless, the comparison with open surgery in the literature is limited to several tens of patients. In this paper, we aim to summarize our experience reporting data of a large group of patients.
Results
We conducted a retrospective analysis of anonymized data from patients who underwent surgical interventions at three clinical centers. A total of 78 boys and 33 girls (M:F 2.36:1) were included in our study. Eighty-seven of them underwent mini-invasive surgery (group 1); 24 were operated in a conventional manner (group 2). The predominant form of the urachal anomaly found was the cyst (58.5%), while an umbilical sinus was present in 47 patients (42.3%), a bladder diverticulum in 7 (6.3%), and a patent urachus in 3 cases (2.7%). The average duration of surgery was 60.7 min (20–192 min) in group 1 and 42.7 min (20–90 min) in group 2; excluding the cases with simultaneous interventions, the average duration was found to be 54.5 and 39.7 min, respectively. Twenty-nine simultaneous operations for associated pathologies were performed in 19 cases (21.8%) in our MIS group, in 8 of them (9.19%) for a preoperatively unknown associated pathology, compared to 4 simultaneous operations performed in 4 patients (16.7%) in the open surgery group. We observed intra-operative complications in 2 cases in Group 1; early postoperative complications included hematuria in 14 cases (16%). The duration of postoperative analgesia was significantly shorter in the MIS group.
Conclusions
Laparoscopic surgery has better cosmetic results and allows for additional diagnostics and simultaneous operations that in turn lead to a shorter duration of postoperative analgesia, but has a longer duration in comparison to an open technique.
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Outcomes of laparoscopic resection of urachal remnants followed by novel umbilicoplasty. Int Urol Nephrol 2018; 50:2167-2172. [PMID: 30276602 DOI: 10.1007/s11255-018-1998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of the study was to report the outcomes of our modified techniques of laparoscopic urachal resection, followed by novel umbilical-plasty using dermal regenerative grafts for symptomatic urachal remnants. METHODS Between March 2014 and December 2016, laparoscopic urachal resection was carried out on 45 patients with complaints of urachal remnants. After extraction of the specimen and closure of the fascia at the umbilical site, a 1-cm square section of dermal regeneration sheet (TERUDERMIS®, Olympus) was suture retained between the fascia and the skin. Patient satisfaction with cosmesis was scored prospectively using the visual analogue scale (VAS). Perioperative records were reviewed to assess surgical outcomes. RESULTS Laparoscopic urachal resection was successfully conducted via the transperitoneal approach. Postoperative bleeding was experienced in one patient (2.2%), which was subsequently controlled laparoscopically. Infection subsided with symptomatic relief in all patients. No symptomatic recurrences were encountered. Over 80% of patients (37/45) rated the cosmetic outcome of the plasty as good to excellent, with the median scores of 8 (range 5-10). CONCLUSIONS Laparoscopic urachal resection is safe and curative with reasonable risk of complications. Novel umbilicoplasty using dermal regenerative graft is very simple technique and offers satisfactory cosmetic outcomes. Further follow-up and cosmesis evaluation are required.
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Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants. Int Urol Nephrol 2017; 49:1965-1971. [PMID: 28828600 DOI: 10.1007/s11255-017-1678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Symptomatic urachal remnants are rare benign anomalies affecting young adults. For these patients, both curative treatment and acceptable postoperative aesthetic outcomes are important. Here, we describe a novel transumbilical approach, using Y-shaped incisions and three-flap umbilicoplasty techniques, to improve repair and aesthetic outcomes. MATERIALS AND METHODS The clinical and perioperative data of 16 patients (11 men; median age, 25 years; range 16-46 years) who underwent LESS surgery and three-flap umbilicoplasty (LESS group) between December 2013 and March 2017 were analyzed. For comparison, the perioperative data of those who underwent conventional laparoscopic surgery (CL group) between May 2010 and November 2013 at the same institutions were investigated. RESULTS The median operative time of the LESS group was longer than that of the CL group (146.5 vs 107 min; p = 0.009). The estimated blood loss and postoperative hospital stay were not significantly different between the two groups. The two perioperative complications were injury to the transverse colon serosa and minor surgical site infection. Both complications were resolved with appropriate management. CONCLUSIONS This novel umbilical approach is useful for patients with symptomatic urachal remnants, with the reduction in port-site scarring resulting in good postoperative cosmesis.
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Kilday PS, Finley DS. Robot-Assisted Excision of a Urachal Cyst Causing Dyspareunia and Dysorgasmia: Report of a Case. J Endourol Case Rep 2016; 2:3-5. [PMID: 27579400 PMCID: PMC4996573 DOI: 10.1089/cren.2015.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Urachal remnants are a group of rare anatomical anomalies that include cysts, diverticula, and tumors. We present a case of a young female patient with dyspareunia and dysorgasmia related to a urachal cyst. Case: A patient with unique presentation of urachal cyst treated robotically. Patient had complete resolution of symptoms postoperatively. Conclusion: Robot-assisted excision of the urachal remnant provided durable symptom relief.
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Affiliation(s)
- Patrick S. Kilday
- Department of Urology, Kaiser Permanente Los Angeles, Los Angeles, California
| | - David S. Finley
- Department of Urology, Kaiser Permanente Los Angeles, Los Angeles, California
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Abstract
BACKGROUND The urachus and the urachal remnants represent a failure in the obliteration of the allantois at birth that connects the bladder to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Urachal cyst are the most common urachal anomaly in the pediatric population. The traditional surgical approach is a semicircular infraumbilical incision or a lower midline laparotomy. METHODS In a 10 years period at Pediatric Surgery Department of Vicenza 16 children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms. Eight underwent open excision; eight were treated by laparoscopic surgery. The average age was 5.5 years (range, 4 months-13 years) in open group and 10 years (range, 1 month-18 years) in laparoscopic group. RESULTS Mean operative time was 63 minutes (range, 35-105 minutes) in open group, 50 minutes (range, 35-90 minutes) in laparoscopic group. There were no postoperative complications. The patients of laparoscopic group were all discharged after few days (range, 2-4 days). Pathological examination confirmed a benign urachal remnant in all cases. Reporting our experience since comparing the two surgical approaches we want to describe the technique step by step of laparoscopic urachal cyst excision as minimally invasive diagnostic and surgical techniques. CONCLUSIONS Laparoscopy represents a useful alternative for the management of persistent or infected urachus, in particular when there's the suspect despite the lack of radiological evidence. The morbidity associated with this approach is very low as the risk or recurrence. Laparoscopy in the management of urachal cyst is safe effective and ensures good cosmesis with all the advantages of minimally invasive approach.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
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Chaump M, Giorgadze T, Schreiner AM. Urine cytology: Pitfall due to a "remnant" lesion. Cytojournal 2015; 12:16. [PMID: 26288651 PMCID: PMC4527229 DOI: 10.4103/1742-6413.161604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Chaump
- Address: 525 East 68 Street, Room F-766, New York Presbyterian Hospital, Weill Cornell Medical Center, Papanicolaou Cytology Laboratory, New York, NY 10065, USA
| | - Tamar Giorgadze
- Address: 525 East 68 Street, Room F-766, New York Presbyterian Hospital, Weill Cornell Medical Center, Papanicolaou Cytology Laboratory, New York, NY 10065, USA
| | - Andrew M Schreiner
- Department of Pathology, New York Hospital Queens, Flushing, NY 11355, USA
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Umbilical reconstruction in children: a simplified operative technique. Aesthetic Plast Surg 2015; 39:414-7. [PMID: 25762154 DOI: 10.1007/s00266-015-0465-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The umbilicus has a paramount aesthetical function for the abdomen and when removed due to a surgical procedure, an umbilicoplasty is mandatory: indeed, its absence could contribute to the development of psychological disorders, especially in childhood. Herein, we describe a straightforward technique to obtain a seemingly natural umbilical scar. This technique, easily taught in a general pediatric surgery environment, may be amenable for any kind of umbilical reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Siow SL, Mahendran HA, Hardin M. Laparoscopic management of symptomatic urachal remnants in adulthood. Asian J Surg 2015; 38:85-90. [DOI: 10.1016/j.asjsur.2014.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/18/2014] [Accepted: 04/24/2014] [Indexed: 12/26/2022] Open
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Masuko T, Uchida H, Kawashima H, Tanaka Y, Deie K, Iwanaka T. Laparoscopic Excision of Urachal Remnants Is a Safe and Effective Alternative to Open Surgery in Children. J Laparoendosc Adv Surg Tech A 2013; 23:1016-9. [DOI: 10.1089/lap.2013.0127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takayuki Masuko
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
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Sato F, Shin T, Yuki H, Liang M, Ando T, Mori K, Nomura T, Mimata H. Umbilical laparoendoscopic single-site technique for complete excision of urachal remnant. J Laparoendosc Adv Surg Tech A 2012; 22:899-903. [PMID: 23067067 DOI: 10.1089/lap.2012.0245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Infected urachal remnant is an uncommon benign disease but is generally symptomatic and commonly recurs. The standard of care for this disease is complete resection of all anomalous tissue including a bladder cuff to avoid recurrence. Recent minimally invasive laparoscopic techniques can effectively manage this disease, but multiport laparoscopic techniques are reported to still leave scars outside the umbilicus. SUBJECTS AND METHODS A novel technique of umbilical laparoendoscopic single-site (LESS) surgery for 2 patients with symptomatic urachal remnant is presented in this study. RESULTS In both cases, the entire urachal tissues from the umbilicus to the anterior bladder dome were successfully excised by the umbilical LESS technique without any extra ports or needlescopes. An articulating needle holder enabled water-tight bladder closure, resulting in early removal of the indwelling catheter. Without any signs of infection, the wound healings were completed 4 weeks after surgery in both cases. The patients had no complaints of symptoms at 6 months and 4 months, respectively, after surgery,and they were quite satisfied with their cosmetic results. CONCLUSIONS We propose that the umbilical LESS technique is a promising surgical option for patients with a symptomatic urachal remnant and that this technique provides satisfactory cosmetic results.
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Affiliation(s)
- Fuminori Sato
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
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