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Bertoni M, Pintucci A, Locatelli A, Miranda A. Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient. Int J Surg Case Rep 2024; 118:109584. [PMID: 38579600 PMCID: PMC11004866 DOI: 10.1016/j.ijscr.2024.109584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Urachal cyst infections during pregnancy are exceptionally rare, posing diagnostic challenges. This case report contributes to the limited literature, emphasizing the rarity, diagnostic difficulties, and the need for heightened healthcare provider awareness for timely intervention. PRESENTATION OF CASE A 32-year-old pregnant woman with persistent pelvic pain, fever, and urinary symptoms sought care with inconclusive initial diagnoses despite multiple ER visits. Labor revealed a palpable mass, and postpartum, a CT scan identified a urachal cyst abscess. Urgent laparoscopy confirmed peritonitis, leading to cyst removal, antibiotics, and a subsequent laparotomy. Histology confirmed an abscessed urachal cyst. DISCUSSION Urachal cyst infections in pregnancy, exceptionally rare and diagnostically challenging, highlight the importance of considering them in abdominal pain differentials. Diagnostic tools, such as ultrasound and CT scans, can be misleading, emphasizing the necessity for a multidisciplinary approach. CONCLUSION This case report underscores the challenges in diagnosing and managing an infected urachal cyst during pregnancy, stressing the need for awareness and a comprehensive diagnostic approach for optimal outcomes. The rarity of such cases warrants increased attention within the medical community.
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Affiliation(s)
- Martina Bertoni
- School of Medicine and Surgery, University of Milano Bicocca, Italy.
| | - Armando Pintucci
- Obstetrics and Gynecology, Pio XI Hospital, Desio, ASST Brianza, Italy.
| | - Anna Locatelli
- Obstetrics Unit, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.
| | - Angelo Miranda
- General Surgery, Pio XI Hospital, Desio, ASST Brianza, Italy.
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2
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Gelikman DG, Ibanez KR, Ghattas YS, Craver EC, Casas-Melley AT, Ellsworth P, Seth A. Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery. J Pediatr Urol 2024; 20:75.e1-75.e8. [PMID: 37802719 DOI: 10.1016/j.jpurol.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. OBJECTIVE To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. STUDY DESIGN All patients diagnosed with a UA from 2016 to 2020 at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. RESULTS Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p < .0001). Though, urology was more likely to treat patients who presented incidentally (p < .01), and general surgery was more likely to treat patients who presented with an infected remnant (p < .01). Patients of male sex were more likely overall to receive surgery compared to female patients (p < .01). DISCUSSION Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. CONCLUSIONS Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.
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Affiliation(s)
- David G Gelikman
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Kristen R Ibanez
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Emily C Craver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Adela T Casas-Melley
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Pediatric Surgery, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Pamela Ellsworth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Abhishek Seth
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA.
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Chejara R, Goyal S, Choudhary S, Shah S. Urachal Adenocarcinoma: a Case Report and Review of the Literature. Indian J Surg Oncol 2023; 14:677-681. [PMID: 37900644 PMCID: PMC10611656 DOI: 10.1007/s13193-023-01736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Urachal adenocarcinoma is one of the rare and aggressive neoplasms that often presents at an advanced stage and has a poor prognosis. Urachal adenocarcinoma makes up 0.17 to 0.34% of all bladder carcinomas. Patients commonly present with hematuria. Wide local excision of urachal mass with umbilicus and surrounding soft tissue en bloc combined with partial or radical cystectomy and bilateral pelvic lymphadenectomy is considered to be the primary surgical management. However, many publications in literature report that en bloc removal of tumor with umbilicus, entire urachal ligament, and bladder dome alone has long-term survival and disease-free period. Here, we present a case of a 50-year-old post-menopausal female patient with a fungating mass in the umbilical region of size approximately 10 cm in maximum diameter with mucopurulent discharge from the mass. The patient had no history of any hematuria, mucinuria, burning micturition, or any particles in urine. A laparotomy was performed, and tumor mass along with the cuff of the bladder dome was removed as en bloc along with umbilectomy. This case report highlights a rare case of urachal adenocarcinoma with a fungating mass of large size in a female patient which is otherwise more commonly seen in males. A review of published literature is also presented.
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Affiliation(s)
- Rajkumar Chejara
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunny Goyal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sushila Choudhary
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sameeksha Shah
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Taktak S, El-Taji O, Hanchanale V. Modern methods in managing urachal adenocarcinoma. Curr Urol 2023; 17:188-192. [PMID: 37448609 PMCID: PMC10337813 DOI: 10.1097/cu9.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/13/2022] [Indexed: 03/12/2023] Open
Abstract
Objectives We sought to evaluate modern diagnostic and treatment options for urachal adenocarcinoma (UAC) and to provide clarity regarding the available options and their outcomes for this poorly understood yet damaging disease. Material and methods We conducted a systematic literature search in PubMed and Medline focusing on updated management of UAC. Results Surgical intervention continues to be the mainstay of treatment for localized UAC. However, with the increased availability of molecular and genetic profiling, chemotherapy has consistently demonstrated promising response rates and survival outcomes, especially for a disease that commonly presents in a metastatic stage. The role of checkpoint inhibitors remains under investigation. Cross-sectional imaging is vital during postoperative surveillance. However, there may also be a role for the adoption of cystoscopy to detect bladder recurrence. Conclusions Although the importance of surgical resection remains unchanged, improved survival outcomes with chemotherapy have been found in small retrospective studies. Randomized trial data are required to further assess the influence of systemic treatment as a primary or adjuvant therapy. Moreover, a stringent follow-up regimen incorporating evaluation for distant and local recurrence of UAC must be evaluated and adopted.
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Affiliation(s)
- Samih Taktak
- Department of Urology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Chebbi S, Saadi A, Mokadem S, Chakroun M, Blel A, Ben Slama MR. Inflammatory suppurated tumor of urachus mimicking a malignant urachus adenocarcinoma. Urol Case Rep 2023; 50:102531. [PMID: 37664532 PMCID: PMC10469526 DOI: 10.1016/j.eucr.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/13/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
This is a case report about a patient presenting with a urachal mass mimicking a urachus adenocarcinoma. Cystoscopy showed a vesicourachal patent diverticulum. Histological findings after the removal of the umbilicus, urachus, urachal tumor, as well as a bladder cuff, consisted of a nonspecific polymorphous suppurative inflammatory infiltrate. Urachal adenocarcinoma is an aggressive tumor with poor prognosis if not treated while it is still localized. Surgical excision is the only recommended treatment that offers the best chances of survival. As no preoperative procedure has been proven accurate enough to rule out the diagnosis of adenocarcinoma, surgery appears to be inevitable.
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Affiliation(s)
- Sami Chebbi
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Ahmed Saadi
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Seif Mokadem
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Ahlem Blel
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Pathology Department, Tunisia
| | - Mohamed Riadh Ben Slama
- University of Tunis El Manar, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
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Jain K, Jain E, DiLena R, Saleeb R, Jain U. Urachal xanthogranuloma: a rare but important case presenting as a urachal mass. BMC Urol 2023; 23:132. [PMID: 37537591 PMCID: PMC10398907 DOI: 10.1186/s12894-023-01297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND A urachal mass is a relatively rare presentation to the urologists' practice, often requiring radical surgical excision for a definitive diagnosis. Xanthogranulomatous inflammation of the urachus is an extremely rare entity with few cases reported worldwide, and to the best of our knowledge, no cases reported in the western world. CASE PRESENTATION In this case, a 55-year-old male patient presented with bothersome lower urinary tract symptoms and computed tomography findings demonstrating a urachal mass that was worrisome for urachal carcinoma. Following surgical intervention, histopathology revealed urachal xanthogranuloma. Post-operatively, the patient recovered well, and eventually, he had symptomatic and radiologic improvement. CONCLUSION This case brings awareness to a rare presentation of a urachal mass-urachal xanthogranuloma. While operative intervention was both diagnostic and therapeutic, we highlight the challenge in differentiating between benign and malignant processes for urachal masses. Herein, we show the importance of including urachal xanthogranuloma in the differential diagnosis of a urachal mass to prevent further morbidity associated with the treatment of this disease.
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Affiliation(s)
- Kunal Jain
- Section of Urology, Department of Surgery, University of Manitoba, AE101-820 Sherbrook St, University of Manitoba (Bannatyne Campus), Winnipeg, MB, R3A 1R9, Canada.
| | - Esha Jain
- Department of Family Medicine, Cooper Medical School of Rowan University, Camden, NJ, Canada
| | - Richard DiLena
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rola Saleeb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Umesh Jain
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Stokkel LE, van Rossum HH, van de Kamp MW, Boellaard TN, Bekers EM, Kok NFM, van Rhijn BWG, Mertens LS. Clinical value of preoperative serum tumor markers CEA, CA19-9, CA125, and CA15-3 in surgically treated urachal cancer. Urol Oncol 2023; 41:326.e17-326.e24. [PMID: 36813613 DOI: 10.1016/j.urolonc.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/20/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Urachal adenocarcinoma (UrAC) is a very rare malignancy with a poor prognosis. The role of preoperative serum tumor markers (STMs) in UrAC is unknown. The aim of this study was to assess the clinical value of elevated STMs including carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), and cancer antigen 15-3 (CA15-3) in surgically treated UrAC, and to evaluate their prognostic significance. METHODS This was a retrospective study of consecutive patients with histopathologically confirmed UrAC who underwent surgical treatment at a single tertiary hospital. Blood levels of CEA, CA19-9, CA125, and CA15-3 were determined before surgery. The proportion of patients with elevated STMs was calculated, as well as the association between elevated STMs and clinicopathological characteristics, recurrence-free survival and disease-specific survival. RESULTS Of the 50 patients included; CEA, CA 19-9, CA125, and CA15-3 were elevated in 40%, 25%, 26%, and 6% respectively. Elevated CEA was associated with higher pT-stage (odds ratio [OR] 3.3 [95% confidence interval 1.0-11.1], P = 0.003), higher Sheldon stage (OR 6.9 [95% CI 0.8-60.4], P = 0.01), male sex (OR 4.7 [95% CI 1.2-18.3], P = 0.01), and the presence of peritoneal metastases at the time of diagnosis (OR 3.5 [95% CI 0.9-14.2], P = 0.04). Elevated CA19-9 was associated with signet-cell component (OR 1.7 [95% CI 0.9-3.3], P = 0.03) and elevated CA125 was associated with peritoneal metastases at the time of diagnosis (OR 6.0 [95% CI 1.2-30.6], P = 0.04). Elevated STMs before surgery were not associated with recurrence-free survival and/or disease-specific survival. CONCLUSION A subset of patients with surgically treated UrAC has elevated STMs preoperatively. CEA was most frequently (40%) elevated and correlated with unfavorable tumor characteristics. However, STM levels did not correlate with prognostic outcomes.
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Affiliation(s)
- Laura E Stokkel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Huub H van Rossum
- Department of Analytical Chemistry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maaike W van de Kamp
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Ma W, Ma X, Jiang L, Yang W, Zhang J, Mu F, Li S. A Giant Urachal Accessory Spleen: Case Report. Urol Int 2023; 107:747-750. [PMID: 37321190 DOI: 10.1159/000530890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 06/17/2023]
Abstract
Accessory spleen (AS) refers to single or multiple splenic tissues which appear outside the relative normal spleen position results from embryonic dysplasia similar in structure and function to the spleen. AS is frequently observed in the splenic hilus and or adjacent to the tail of pancreas, and only a few cases occurred in the pelvic cavity. We present an extremely rare AS case in urachus, which was initially considered as an urachal neoplasm revealed on CT images with big mass. However, the postoperative pathology confirmed it was an AS that had not been reported at urachal before. Urachal AS can be misdiagnosed as a tumor, so it is vital to make an accurate imaging preoperative diagnosis to avoid unnecessary biopsy and surgery.
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Affiliation(s)
- Wenmin Ma
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China,
| | - Xuejin Ma
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Lin Jiang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Wei Yang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Jiaren Zhang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Fangfang Mu
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Shiguang Li
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
- Department of Radiology, The Second People's Hospital of Guiyang, Guiyang, China
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9
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Riaza Montes M, Antón Eguia BT, Gallego Sánchez JA. Urachal sinus: An atypical case and review of the literature. Urol Case Rep 2023; 47:102359. [PMID: 36895469 PMCID: PMC9988468 DOI: 10.1016/j.eucr.2023.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
Urachal sinus is a rare type of urachal abnormality. It happens because of blind focal dilation at the umbilical end and has increased risk of infection. We report the case of a 23-year-old female with abdominal pain and umbilical discharge. Ultrasound detected a possible infected urachal sinus which was initially treated with antibiotic therapy. Urachal sinus excision and laparoscopic bladder raffia was later performed with no recurrence at present. Diagnosis of this pathology is essential given that surgery is curative and avoids complications such as neoplastic transformation.
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Affiliation(s)
- María Riaza Montes
- Department of Urology, Galdakao-Usansolo Hospital, Labeaga Auzoa, 48960, Galdakao, Vizcaya, Spain
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10
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Mohamed G, Ghani Z, Lynn N, Masilamani M, Rowlands J. Vesicourachal diverticulum. Ann R Coll Surg Engl 2022; 104:e255-e257. [PMID: 35446699 PMCID: PMC9685905 DOI: 10.1308/rcsann.2021.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/03/2023] Open
Abstract
We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
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Affiliation(s)
- G Mohamed
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - Z Ghani
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - N Lynn
- Shrewsbury and Telford Hospital NHS Trust, UK
| | | | - J Rowlands
- Shrewsbury and Telford Hospital NHS Trust, UK
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Zenitani M, Nose S, Oue T. Prevalence of urachal remnants in children according to age and their anatomic variants. Pediatr Surg Int 2022; 38:1495-1500. [PMID: 35879470 DOI: 10.1007/s00383-022-05183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The aim of this study was to elucidate the prevalence of urachal remnants in children in relation to patient age as well as to identify their anatomic variants, using a laparoscopic view. METHODS The medical records of 394 pediatric patients who underwent laparoscopic inguinal hernia repair were reviewed. Patients were divided into four groups based on their age at surgery. Using laparoscopic visualization, the presence and anatomic variants of urachal remnants were analyzed. RESULTS A urachal remnant was confirmed in 140 children (35.5%). Although the prevalence was significantly higher in the group of children aged < 1 year (63.2%) than in any other group, no significant difference in the prevalence was observed between the groups aged ≥ 1 year. In 42 cases (10.7%), the urachal remnant merged into the lateral umbilical ligament. CONCLUSIONS Our results suggest a recommendation of nonoperative management of asymptomatic urachal remnants, especially in patients less than 1 year of age due to its probable spontaneous resolution. Knowledge of the anatomic variants could improve the accuracy of diagnosis of urachal remnants and the comprehension of its structure and localization for the achievement of accurate and complete excision.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Satoko Nose
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
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12
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Smith SM, Yuan N, Stelmar J, PA-C GL, Gupta A, Kim HL, Garcia MM. An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap. Sex Med 2022; 10:100572. [PMID: 36183656 PMCID: PMC9780766 DOI: 10.1016/j.esxm.2022.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Gender-affirming peritoneal vaginoplasty has been described, and previous descriptions are modifications of the Davydov technique. AIM To describe our alternative technique for gender-affirming peritoneal vaginoplasty (PV) using a single-pedicled, urachus-peritoneal hinge flap, discussing proposed advantages. METHODS Retrospective review of all consecutive transfeminine patients with neovaginal shortening after prior penile inversion vaginoplasty (PIV) who underwent our PV technique from May 2019 to July 2022. PV was performed via combined transperineal and laparoscopic (robot-assisted) approaches. After spatulation of the neovaginal remnant, a midline, inferiorly based urachus-peritoneal hinge flap was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The free end of the flap was flipped posteriorly and sutured to posterior edge of the open canal remnant, forming a peritoneal pouch. The lateral edges of the pouch were sutured together for water-tight closure. Patients resumed dilation on POD 6 and douching on POD 10. MAIN OUTCOME MEASURES Ten transfeminine patients underwent PV, with good outcomes. We measured: Pre-op penile and scrotal skin lengths, intra-op tubularized scrotal skin length, pre and post-op vaginal depth and width (immediate and at last follow-up). RESULTS Pre-op: mean neovaginal depth was 9.2cm (SD 1.5); width was 12cm. Immediate post-op: mean depth was 15.1 cm (SD 2.2 cm, mean net increase: 5.9 cm). At mean follow-up of 18.3 months, mean depth was 12.5 cm (SD 2.1 cm, mean net increase: 3.3 cm) and width was 12 cm. There were no immediate post-op complications. Eight (80%) of the 10 patients report satisfactory vaginal receptive intercourse. The other 2 have not yet attempted vaginal receptive intercourse. CLINICAL IMPLICATIONS Advantages of the proposed technique over existing techniques include no tension on peritoneal suture lines and total exclusion of the rectum. STRENGTHS AND LIMITATIONS Strengths include a short learning curve for urologic surgeons with robotic experience. The study is limited by small sample size. CONCLUSIONS Our PV technique is a safe and effective option for salvage peritoneal vaginoplasty after primary PIV. Smith SM, Yuan N, Stelmar J, et al. An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap. Sex Med 2022;10:100572.
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Affiliation(s)
- Shannon M. Smith
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nance Yuan
- Huntington Plastic Surgery Institute, Pasadena, CA, USA
| | - Jenna Stelmar
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Grace Lee PA-C
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amit Gupta
- Beverly Hills Urology, Beverly Hills, CA, USA
| | - Hyung L. Kim
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maurice M. Garcia
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Departments of Anatomy and Urology, University of California San Francisco, San Francisco, CA, USA,Corresponding Author: Maurice M. Garcia, MD, MAS, 8635 W. Third St., Suite 1070W, Los Angeles, CA 90048, USA.
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13
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Neymeyer J, Çubuk A, Handke IM, Şahan A, Özkaptan O, Aslan AR, Schlomm T. Transurethral suturing of bladder following transurethral excision of female vesico-urachal diverticula: a novel technique with long-term follow-up results. Clin Exp Nephrol 2022. [PMID: 35819651 DOI: 10.1007/s10157-022-02248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUNDS This study aims to describe and evaluate outcomes of transurethral surgery-natural orifice transluminal endoscopic surgery (TUS-Notes) technique in patients treated with transurethral excision of vesico-urachal diverticula (VD). METHODS Patients who underwent TUS-Notes following transurethral VD excision due to recurrent urinary tract infection (rUTI) since 2013 were included in this prospective non-randomized cohort study. Under cystoscopic guidance VD and surrounding bladder wall was resected until the fatty tissue using monopolar resectoscope. The specimen was removed with a grasper through the cystoscope. TUS-Notes technique was performed with Minimal Suturing Device (MSD-Ney®). The needle of the suture was shaped according to suturing position and loaded into MSD-Ney. They were inserted into the bladder under cystoscopic guidance transurethrally. Once the defect was sutured properly, an extracorporeal knot was prepared and tied. The length of the operation (LOO), and perioperative complications according to the Clavien-Dindo grading system were noted. The integrity of the bladder was checked with cystography to assess objective cure. Subjective cure was evaluated with Patient Global Impression of Improvement (PGI-I) scale. RESULTS The follow-up period of 65 participants varied from three months to eight years. The median LOO was 37 min. A Clavien grade-3 complication was observed in one patient. Peroperative failure was not noted. The median duration of hospital stays, and catheterization time was three days. Objective cure rate and subjective cure rates were 100%. UTI was not noted after surgery. CONCLUSIONS Transurethral complete excision of VD is an acceptable technique to prevent rUTI. The TUS-Notes technique provides a successful minimal invasive treatment option for the treatment of bladder defects. CONCISE Transurethral suturing of urinary bladder.
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14
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Faye P, Gueye M, Thiam O, Niasse A, Ndong A, Ndiaye M, Seye Y, Sarr I, Seck M, Toure A, Cisse M. Infected urachal cyst in an adult, report of two observations. Int J Surg Case Rep 2022; 97:107394. [PMID: 35834928 PMCID: PMC9403061 DOI: 10.1016/j.ijscr.2022.107394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it. CASE PRESENTATION Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection. CLINICAL DISCUSSION Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery. CONCLUSION Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.
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Affiliation(s)
- P.M. Faye
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal,Corresponding author at: General Surgery department, Dalal Jamm Hospital, Dakar, Senegal.
| | - M.L. Gueye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O. Thiam
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal
| | - A. Niasse
- Surgery department of Matlaboul Fawzeyni Hospital, Touba, Senegal
| | - A. Ndong
- General Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - M. Ndiaye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - Y. Seye
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - I.S.S. Sarr
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M. Seck
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A.O. Toure
- General Surgery department of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M. Cisse
- General Surgery department of Dalal Jamm Hospital, Dakar, Senegal
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15
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Chen YH, Tseng JS. Concurrent urachal abscess and florid cystitis glandularis masquerading as malignancy: a case report and literature review. BMC Surg 2022; 22:105. [PMID: 35313861 DOI: 10.1186/s12893-021-01430-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The urachus is the embryological remnant of the cloaca and allantois. Failure of its regression can cause diseases any time after birth. It is difficult to differentiate an abscess from urachal adenocarcinoma based on the clinical presentation and image findings. Cystitis glandularis reflects chronic irritation of the bladder urothelium, and tumor-like florid cystitis glandularis can be misdiagnosed as malignancy. We report a patient with concurrent urachal abscess and florid cystitis glandularis which increased the resemblance of malignancy. CASE PRESENTATION A 57-year-old female was incidentally found to have a heterogeneous pelvic mass abutting the urinary bladder. A cystoscopy examination revealed protruding tumors located in the bladder dome. Her blood test results were all normal, and urinalysis showed microscopic hematuria. Urachal cancer was diagnosed and en bloc excision of the umbilicus, tumor, and the involved bladder dome was performed. Pathology revealed urachal abscess with concurrent cystitis glandularis within the urinary bladder. No malignancy was identified in the resected specimen. CONCLUSIONS It is challenging to distinguish urachal abscess from a malignant tumor based on the clinical presentation and imaging studies. As in our case, the coexistence of urachal abscess and tumor-like florid cystitis glandularis increased the resemblance to a malignancy. This is the first reported case of the concurrence of these two disease entities, and emphasizes that the detection of bladder tumors on cystoscopy is not sufficient to make the diagnosis of urachal cancer with bladder involvement.
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16
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DeNotta SL. Urinary Tract Disorders of Foals. Vet Clin North Am Equine Pract 2022; 38:47-56. [PMID: 35282963 DOI: 10.1016/j.cveq.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Urinary disease in the neonatal period can occur with primary congenital renal defects or as a secondary consequence of birth trauma, ischemic injury, nephrotoxic medications, or systemic illness. This article reviews the clinical evaluation of the urinary system in foals and highlights diagnostic and therapeutic features of the most commonly encountered urinary disorders of the equine neonatal patient.
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Affiliation(s)
- SallyAnne L DeNotta
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, PO Box 10036, Gainesville, FL 32610, USA.
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17
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Stokkel LE, van de Kamp MW, Schaake EE, Boellaard TN, Hendricksen K, van Rhijn BWG, Mertens LS. Robot-Assisted Partial Cystectomy versus Open Partial Cystectomy for Patients with Urachal Cancer. Urol Int 2022; 106:840-847. [PMID: 35134799 DOI: 10.1159/000521605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC. METHODS We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification. RESULTS Median follow-up was 40 months (IQR 21-95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56-89 months) and 60% (95% CI; 42-78 months), respectively, versus 90% (95% CI; 85-95 months) and 66% (95% CI; 59-73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27). CONCLUSION Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.
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Affiliation(s)
- Laura E Stokkel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maaike W van de Kamp
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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Abdelhadi JM, Shalgum AA, Abushhiwa M. A rare urachal abscess in a young bull with conservative management. Open Vet J 2022; 12:628-631. [PMID: 36589410 PMCID: PMC9789760 DOI: 10.5455/ovj.2022.v12.i5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background The urachus is an embryonic remnant occurring as a result of the involution of the allantoic duct and the ventral cloaca. This canal becomes progressively obliterated after birth. It uncommonly persists to different degrees after birth. Case Description A young bull was presented with distended abdomen and clinical signs of chocking, with low-grade fever, loss of appetite, frothy mouth arched back. On the first inspection, the animal was suspected to have simple indigestion. The treatment was attempted in this stage by introducing a stomach tube but only little relief was achieved. Therefore, 5 days later, an exploratory laparotomy was done and a big balloon-like cyst structure extended ventro-latrally in the abdominal cavity was noticed. That structure was located on the floor of the abdominal cavity extending from the pelvic rim caudally to the umbilical region cranially. The structure was then incised and evacuated and a rubber tube was fixed for constant drainage for up to one month later. The bull was followed-up and made a good recovery after a month post-surgery. Conclusion We found that urachal abscess could be treated simply via surgical evacuation of the abscess and proper drainage for some time with a very promising outcome. Additionally, this affection can be diagnosed based on history, clinical signs, and exploratory surgery, when relatively modern diagnostic techniques are not available.
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Affiliation(s)
- Jalal M. Abdelhadi
- Department of Surgery and Theriogenology, Faculty Veterinary Medicine, University of Tripoli, Tripoli, Libya,Corresponding Author: Jalal M. Abdelhadi. Department of Surgery and Theriogenology, Faculty Veterinary Medicine, University of Tripoli, Tripoli, Libya.
| | - Aiman A. Shalgum
- Department of Anatomy, Histology and Embryology, Faculty Veterinary Medicine, University of Tripoli, Tripoli, Libya
| | - Mohamed Abushhiwa
- Department of Surgery and Theriogenology, Faculty Veterinary Medicine, University of Tripoli, Tripoli, Libya
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19
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Figueroa LM, Escobar G, Osorno J, Acuña M, Solarte J. Peritonealized urachal remnant and obstructive congenital peritoneal band. A case report. Cir Pediatr 2022; 35:46-49. [PMID: 35037441 DOI: 10.54847/cp.2022.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Intestinal obstruction as a result of congenital peritoneal bands is rare in surgical practice. It typically compromises the small bowel, and it also has been reported to involve the appendix or a Meckel's diverticulum. However, peritonealized urachal remnant as part of a congenital band is highly infrequent. CASE REPORT 5-year-old boy presenting with intestinal obstruction related to a peritoneal band from the mesentery to the appendix and a peritonealized urachal remnant, associated with an incidental finding of a Meckel's diverticulum. Diagnosis was achieved laparoscopically. The peritoneal band, the urachal remnant, and the Meckel's diverticulum were resected. DISCUSSION Kerkeni's congenital band classification consists of 4 independent groups. This case combines both a band stemming from an embryological remnant and an idiopathic band.
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Affiliation(s)
- L M Figueroa
- Pediatric Surgery Unit. Surgery Department. Del Valle University. Del Valle University Hospital. Cali, Valle del Cauca (Colombia)
| | - G Escobar
- Pediatric Surgery Unit. Surgery Department. Del Valle University. Del Valle University Hospital. Cali, Valle del Cauca (Colombia)
| | - J Osorno
- Pediatric Surgery Unit. Surgery Department. Del Valle University. Del Valle University Hospital. Cali, Valle del Cauca (Colombia)
| | - M Acuña
- Pediatric Surgery Unit. Surgery Department. Del Valle University. Del Valle University Hospital. Cali, Valle del Cauca (Colombia)
| | - J Solarte
- Pediatric Surgery Unit. Surgery Department. Del Valle University. Del Valle University Hospital. Cali, Valle del Cauca (Colombia)
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20
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Flammia RS, Chierigo F, Würnschimmel C, Horlemann B, Hoeh B, Sorce G, Tian Z, Leonardo C, Tilki D, Terrone C, Saad F, Shariat SF, Montorsi F, Chun FK, Gallucci M, Karakiewicz PI. Survival benefit of chemotherapy in a contemporary cohort of metastatic urachal carcinoma. Urol Oncol 2021; 40:165.e9-165.e15. [PMID: 34686429 DOI: 10.1016/j.urolonc.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/12/2021] [Accepted: 09/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND We relied on the most contemporary Surveillance, Epidemiology, and End Results (SEER) database and tested the hypothesis that chemotherapy may improve survival in metastatic urachal carcinoma (m-UraC). MATERIAL AND METHODS Within the SEER database (2004-2016), we identified m-UraC patients aged ≥ 18 years. Propensity score matching (PSM: cystectomy status, age and sex), Kaplan-Meier plots, cumulative incidence plots, Cox regression models and competing risks regression (CRR) models addressed overall mortality (OM) and cancer-specific mortality (CSM). RESULTS Overall, 274 m-UraC patients were identified with a median age of 70 years. Most were male (66%) and Caucasian (72%). Overall, 32% received chemotherapy. Chemotherapy-exposed patients were younger (62 vs. 73 years, p<0.001) and more frequently underwent cystectomy (19 vs. 8%, P = 0.014). In 274 m-UraC patients, median OM and CSM were 6 (4 -10) months and 8 (6 -14) months, respectively. After 1:1 PSM, chemotherapy-exposed patients exhibited lower OM (median 16 vs. 3 months; multivariable HR 0.38, P <0.001) and lower CSM (median 17 vs. 4 months; multivariable CRR HR 0.52, P = 0.001). The association between chemotherapy and better survival was even stronger in younger (≤70 years) patients (OM HR: 0.23, P <0.001; CSM CRR HR: 0.42, P = 0.001), but not in older (≥71 years) patients (OM HR: 0.61, P = 0.2; CSM CRR HR: 1.02, P = 1), after PSM and multivariable adjustments. CONCLUSION Overall, we validated the very aggressive nature of UraC, when distant metastases are present, and observed that m-UraC patients exposed to chemotherapy exhibited lower OM and CSM.
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Affiliation(s)
- Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Horlemann
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zhen Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Terrone
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Departments of Urology, Weill Cornell Medical College, New York, New York, USA; Department of Urology, University of Texas Southwestern, Dallas, Texas, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Felix Kh Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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21
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Creffier C, Broome K, Palmer D. Ovarian metastasis from a urachal adenocarcinoma primary in a young female. Urol Case Rep 2021; 39:101797. [PMID: 34401351 PMCID: PMC8353346 DOI: 10.1016/j.eucr.2021.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Christo Creffier
- Department of Urology, Hawke's Bay Fallen Soldiers' Memorial Hospital, 398 Omahu Road, Camberley, Hastings, New Zealand
| | - Kim Broome
- Department of Urology, Hawke's Bay Fallen Soldiers' Memorial Hospital, 398 Omahu Road, Camberley, Hastings, New Zealand
| | - David Palmer
- Department of Pathology, Hawke's Bay Fallen Soldiers' Memorial Hospital, 398 Omahu Road, Camberley, Hastings, New Zealand
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22
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Chaabouni A, Samet A, Amine Mseddi M, Rebai N, Harbi H, Hadjslimene M. Urachal mucinous cystadenoma: An exceptional entity. Urol Case Rep 2021; 39:101782. [PMID: 34354928 PMCID: PMC8321939 DOI: 10.1016/j.eucr.2021.101782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Ahmed Chaabouni
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | - Ahmed Samet
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | | | - Nouri Rebai
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | - Houcem Harbi
- General Surgery Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
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23
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Keçeli AM, Dönmez Mİ. Are urachal remnants really rare in children? An observational study. Eur J Pediatr 2021; 180:1987-1990. [PMID: 33492442 DOI: 10.1007/s00431-021-03962-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Avni Merter Keçeli
- Radiology, Pediatric Radiology, Konya Training and Research Hospital, Konya, Turkey
| | - Muhammet İrfan Dönmez
- Urology, Pediatric Urology, Konya Training and Research Hospital, Hacışaban Mahallesi, Yeni Meram Cd. No: 97, 42090, Meram/Konya, Turkey.
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24
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García García L, Ballesta B, Rodríguez Talavera J, Morales Orribo N, Carrión A. Urachal Pathology: Review of Cases. Urol Int 2021; 106:195-198. [PMID: 33957634 DOI: 10.1159/000515648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The urachus is an embryologic remnant which is formed from the obliteration of the allantois. Urachal abnormalities are caused when defective obliteration of the urachus happens. They are an infrequent condition. Incidence is estimated to be between 5,000 and 8,000 live births. Its diagnosis and management remain a challenge due to the lack of an specific clinical picture and the controversy about the management. OBJECTIVE The objective of this study is to assess the clinical presentation, diagnosis, therapeutic management, and outcomes of urachal anomalies in our health area. MATERIALS AND METHODS We performed a retrospective review of all cases of urachal anomalies recorded Tenerife (southern health area), La Gomera, and El Hierro Islands during a 5 year period. RESULTS Twenty-three cases of urachal pathology were included. The mean age of presentation was 32 years old. 73.9% were male. 65% were diagnosed in adults. In 30.3% of the cases, it was a casual finding. Symptoms included fever, umbilical exudate, hematuria, abdominal pain, and umbilical granuloma. The main diagnostic tests were ultrasound and computed tomography scan. Treatments were selected conservative management (43.5%), selective resection, partial cystectomy, and radical cystectomy. All patients had a good evolution. However, 2 cases where benign tumors were suspected, clinically, had a final histology of cancer in the specimen. CONCLUSIONS Due to the lack of a specific clinical picture and undefined findings in image tools, diagnosis is difficult and it may be inaccurate. Despite more data are needed, our results suggest that the systematic excision of urachal lesions could result in safer outcomes since cases where a benign lesion is clinically suspected might result in malignant tumors.
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Affiliation(s)
- Lorena García García
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Begoña Ballesta
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Nuria Morales Orribo
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Almudena Carrión
- Department of Urology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Stokkel LE, Stokkel MPM, Donswijk ML, Lahaye MJ, Bekers EM, van Rhijn BWG, Mertens LS. The Diagnostic Value of FDG-PET/CT for Urachal Cancer. Clin Genitourin Cancer 2021; 19:373-380. [PMID: 33858788 DOI: 10.1016/j.clgc.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/13/2021] [Accepted: 03/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urachal carcinoma (UrC) is a rare malignancy that often presents at an advanced stage with metastases in up to a quarter of patients. There is no consensus on the optimal form of staging for patients with UrC. In the present study, we evaluated the diagnostic value of 18F-fluorodeoxyglucose-positron emitted tomography/computed tomography (FDG-PET/CT) for UrC. PATIENTS AND METHODS We evaluated 40 consecutive patients who were staged for urachal cancer between 2010 and 2020. They underwent a total of 62 FDG-PET/CTs (40 for primary staging, and 22 during follow-up), which were compared with standard-of-care contrast-enhanced CT (CECT). The metabolic detection of primary tumors, lymph node metastases (LNMs), peritoneal metastases (PMs), distant metastases (DMs), and local recurrence by FDG-PET/CT was evaluated. Sensitivity and specificity were calculated compared with CECT. Histopathology or follow-up imaging was the reference standard. RESULTS Of all 40 patients, 33 patients (83%) had urachal adenocarcinoma-26 (65%) with a mucinous component and 7 (17%) with invasive urothelial carcinoma. All local UrC tumors could be visualized on CT, and 80% showed increased FDG uptake. At initial staging, FDG-PET/CT detected FDG-avid LNMs, PMs, and DMs in 50%, 17%, and 25% of patients, respectively. These metastases were also visualized on CECT. During follow up, FDG-PET/CT revealed FDG-avid local recurrences that were not seen on CT in two out of eight patients (25%). CONCLUSION The present study demonstrates that most UrC can be visualized on FDG-PET/CT. At initial diagnosis, FDG-PET/CT does not seem to yield additional information compared with CECT; however, FDG-PET/CT may be helpful during follow-up. This is a small study, and the findings should be corroborated with larger series.
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Affiliation(s)
- Laura E Stokkel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Jandou I, Ettanji A, Mohammed E, Moataz A, Mohammed D, Debbagh A, Aboutaieb R. Urachal carcinoma revealed by isolated hematuria. Ann Med Surg (Lond) 2021; 63:102193. [PMID: 33732451 PMCID: PMC7937653 DOI: 10.1016/j.amsu.2021.102193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/20/2022] Open
Abstract
Urachal carcinoma is an aggressive and rare neoplasia of bladder cancer involving the urachus. The diagnostic failure is due to its insidious development as well as its non-specific clinical signs. Management constitutes a real dilemma for urological surgeons. We describe two pathological cases of urachal adenocarcinoma revealed by isolated hematuria. 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.
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Affiliation(s)
- Issam Jandou
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
- Corresponding author. Hay El amal, Bloc 05, N 24, Beni Mellal, 23040, Morocco.
| | - Adnan Ettanji
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Ettaouil Mohammed
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Amine Moataz
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Dakir Mohammed
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Adil Debbagh
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Rachid Aboutaieb
- University Hospital Center, Ibn Rochd, Casablanca, Morocco
- Faculté de médicine et de pharmacie, Casablanca, Morocco
- Laboratoire de santé sexuelle, Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
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Aylward P, Samson K, Raynor S, Cusick R. Operative management of urachal remnants: An NSQIP based study of postoperative complications. J Pediatr Surg 2020; 55:873-7. [PMID: 32145974 DOI: 10.1016/j.jpedsurg.2020.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 12/11/2022]
Abstract
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 < 0.001). 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.
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Alaygut D, Soyaltin E, Camlar SA, Tekin A, Sayan A, Ozdemir T, Alparslan C, Mutlubas F, Yavascan O, Demir BK. Periumbilical swelling, erythema, and discharge in a girl: Answers. Pediatr Nephrol 2020; 35:411-413. [PMID: 31529155 DOI: 10.1007/s00467-019-04354-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/04/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Demet Alaygut
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey.
| | - Eren Soyaltin
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | | | - Ali Tekin
- Ege University, Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey
| | - Ali Sayan
- Tepecik Training and Research Hospital, Department of Pediatric Surgery, Izmir, Turkey
| | - Tunç Ozdemir
- Tepecik Training and Research Hospital, Department of Pediatric Surgery, Izmir, Turkey
| | - Caner Alparslan
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Fatma Mutlubas
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Onder Yavascan
- Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Belde Kasap Demir
- Katip Celebi University, Faculty of Medicine, Department of Pediatric Nephrology, Izmir, Turkey
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Mugarab Samedi V, Miller G, Saade E, Kalaniti K. A giant umbilical cord: Benign finding or surgical emergency? Clin Case Rep 2020; 8:398-399. [PMID: 32128200 PMCID: PMC7044356 DOI: 10.1002/ccr3.2663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/24/2019] [Accepted: 12/08/2019] [Indexed: 11/06/2022] Open
Abstract
Congenital urachal anomalies are usually asymptomatic. However, infection or obstruction of urachal remnant may result in serious complications. The giant umbilical cords with suspected internal communications could contain remnants and require surgical exploration. With timely recognition and surgical intervention, the outcome is generally good.
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Affiliation(s)
- Veronica Mugarab Samedi
- University of SaskatchewanSaskatoonSKCanada
- Department of PediatricsRoyal University HospitalSaskatoonSKCanada
| | - Grant Miller
- University of SaskatchewanSaskatoonSKCanada
- Department of PediatricsRoyal University HospitalSaskatoonSKCanada
| | - Edouard Saade
- University of SaskatchewanSaskatoonSKCanada
- Department of PediatricsRoyal University HospitalSaskatoonSKCanada
| | - Kaarthigeyan Kalaniti
- University of SaskatchewanSaskatoonSKCanada
- Department of PediatricsRoyal University HospitalSaskatoonSKCanada
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Abstract
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.
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Mrad Daly K, Ben Rhouma S, Zaghbib S, Oueslati A, Gharbi M, Nouira Y. Infected urachal cyst in an adult: A case report. Urol Case Rep 2019; 26:100976. [PMID: 31380223 PMCID: PMC6661533 DOI: 10.1016/j.eucr.2019.100976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022] Open
Abstract
The urachus is an embryologic remnant which degenerates after the birth. An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood. Infected urachal cyst is a rare pathology in adult women and it should be considered in the differential diagnosis of acute abdomen. We report here a case of a 50-year-old women with an infected urachal cyst reveled by an acute abdomen.
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Affiliation(s)
| | | | - Selim Zaghbib
- Department of Urology, La Rabta Hospital, Tunis, Tunisia
| | - Amine Oueslati
- Department of Urology, La Rabta Hospital, Tunis, Tunisia
| | - Maroua Gharbi
- Department of Urology, La Rabta Hospital, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, Tunis, Tunisia
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Dethlefs CR, Abdessalam SF, Raynor SC, Perry DA, Allbery SM, Lyden ER, Azarow KS, Cusick RA. Conservative management of urachal anomalies. J Pediatr Surg 2019; 54:1054-1058. [PMID: 30867097 DOI: 10.1016/j.jpedsurg.2019.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Christopher R Dethlefs
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE
| | - Sandra M Allbery
- Department of Radiology, Children's Hospital & Medical Center, Omaha, NE
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska College of Public Health. Omaha, NE
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE.
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Lam SW, Linsen PVM, Elgersma OE. Infection of Previously Closed Urachus Mimicking Malignancy: A Case Report and Literature Review of Radiological Findings to the Diagnosis. Clin Med Insights Case Rep 2019; 12:1179547619843836. [PMID: 31037039 PMCID: PMC6475833 DOI: 10.1177/1179547619843836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
The urachus is a vestigial structure of the allantois and cloaca. It involutes as fetal development progresses to become a fibrous cord, which courses between the umbilicus and bladder dome within the retropubic space. Infection occasionally occurs in patients with congenital patent urachus. Here, we report a patient with infection of a previously closed urachal tract presenting as an abdominal mass. This has rarely been described in the literature. Current knowledge on imaging findings to the diagnosis is discussed.
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Affiliation(s)
- Siu W Lam
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Siu W Lam, Department of Radiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht 3318AT, The Netherlands.
| | - Philip VM Linsen
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Otto E Elgersma
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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TARTAR T, BAKAL U, SARAC M, AKDENIZ I, KAZEZ A. Primary Urachal Hydatid Cyst in a Child: A Case Report. Iran J Parasitol 2019; 14:352-355. [PMID: 31543926 PMCID: PMC6737373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The hydatid cyst (HC) is an endemic parasitic disease worldwide. Although the HC can locate in every part of a body, it rarely occurs over the abdominal wall. A 12-year-old female patient was brought to Department of Pediatric Surgery, Firat University School of Medicine, Elazig, Turkey in 2017. She had been suffering from abdominal pain for one week. A lump was determined underneath her skin in the suprapubic region. It was swollen, tense and movable. A cystic mass filling the midline was found in the radiological bladder superior. It was an anechoic cyst causing ondulation on the muscles of the anterior abdominal wall. The sizes of the mass were measured approximately as 9×7 cm (mesentery cyst?). The cystic mass was occurred in the urachal area of the anterior abdominal wall, not in the abdomen. After the cyst was emptied with applying mini median incision below the umbilicus, we saw the germinative membrane inside the cyst. Diagnosis of the HC was confirmed with the pathologic evaluation. For the differential diagnosis of a pure cystic mass, which can locate in every part of a body, diagnosis of the HC should be considered.
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Sankararaman S, Sabe R, Sferra TJ, Khalili AS. Enterourachal Fistula as an Initial Presentation in Crohn Disease. Pediatr Gastroenterol Hepatol Nutr 2019; 22:90-97. [PMID: 30671379 PMCID: PMC6333586 DOI: 10.5223/pghn.2019.22.1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 01/06/2023] Open
Abstract
Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.
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Affiliation(s)
- Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ramy Sabe
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ali Salar Khalili
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Obara N, Arai K, Fukushima T. Crohn's disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures. Int J Surg Case Rep 2018; 53:70-74. [PMID: 30390487 PMCID: PMC6215960 DOI: 10.1016/j.ijscr.2018.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023] Open
Abstract
Urachal tumor or umbilical discharge in Crohn’s disease are examined for internal fistula from diseased ileum to urachus. En broc resection with intestinal lesion and urachus is performed with successful outcome. Partial cystectomy is sometimes performed with urinary bladder inflamed.
Introduction: A fistula involving a patent urachus in a patient with Crohn’s disease is rare. Here we report ileourachal fistula formation in two patients with Crohn’ disease. Case presentations: The first patient was a 29-year-old man with Crohn’s disease and ileitis, and the second patient was a 43-year-old man with Crohn’s disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn’s disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn’s disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both. Conclusion: In cases of Crohn’s disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Akira Sugita
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kazutaka Koganei
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Ryo Futatsuki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Nao Obara
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Katsuhiko Arai
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Tsuneo Fukushima
- Matsushima Clinic, 220-0045 3-138 Isecho Nishi-ku, Yokohama City, Japan.
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Saida T, Nakao S, Tanaka YO, Yano Y, Satoh T, Minami M. Urachal mucinous adenocarcinoma in the pelvic wall mimicking endometriosis. Radiol Case Rep 2018; 13:955-9. [PMID: 30108674 DOI: 10.1016/j.radcr.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/07/2018] [Accepted: 07/08/2018] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 30-year-old woman who complained of a painful palpable mass. Magnetic resonance imaging revealed an ill-defined mass approximately 8 cm in diameter with internal microcytic components. The mass diffusely involved the subcutaneous tissues, the muscles of the pelvic wall, and urinary bladder via a postoperative scar and resembled endometriosis. The histopathologic diagnosis was mucinous adenocarcinoma arisen from the urachal remnant. This is a very rare case of urachal adenocarcinoma arising mainly in the pelvic wall and mimicking endometriosis on MRI.
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Passoni S, Guerra A, Marengo M. Laparoscopic treatment of an infected urachalcyst and diverticulum in a young adult: Presentation of a case and review of the literature. Int J Surg Case Rep 2018; 49:87-90. [PMID: 29966956 PMCID: PMC6039888 DOI: 10.1016/j.ijscr.2018.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/17/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A urachal remnant is a rare anomaly in adults, with a heterogeneous presentation. We report a case of an infected urachal cyst associated with a urachal diverticulum. PRESENTATION OF CASE We report the case of a 16-year-old male who presented to our hospital with lower abdominal pain without any other signs of general infection. A physical examination revealed umbilical erythema with associated tenderness. All laboratory tests were normal. An ultrasound scan revealed an urachal cyst near the umbilicus and a second cyst near the bladder dome. We decided on a staged treatment with antibiotic administration followed by surgical excision of the urachus during laparoscopy. The patient was discharged on day 10 without complications. Pathology revealed chronic inflammatory tissue without signs of malignancy. DISCUSSION Urachus is a fibrous remnant of the allantois that progressively obliterates after birth, forming the median umbilical ligament. Incomplete regression of the urachal lumen results in several anomalies. These anomalies require treatment when discovered because of an increased risk of infection and neoplastic differentiation. A urachal cyst is the most common type of anomaly, and infection is the usual mode of presentation. Surgical intervention with complete excision of the urachus is the treatment of choice. A staged approach with antibiotic administration followed by surgery is recommended if signs of infection are present. CONCLUSION Urachal anomalies in adulthood are rare, with a nonspecific presentation. However, identifying a urachal anomaly is important because of the increased risk for infection and neoplastic differentiation. The laparoscopic approach is safe and patients recover rapidly.
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Affiliation(s)
- Stefano Passoni
- Department of General Surgery, Bellinzona Regional Hospital, Switzerland.
| | - Adriano Guerra
- Department of General Surgery, Bellinzona Regional Hospital, Switzerland
| | - Michele Marengo
- Department of General Surgery, Bellinzona Regional Hospital, Switzerland
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Srisupundit K, Mahawong P, Charoenratana C, Tongsong T. Prolapsed bladder following rupture of patent urachal cyst, mimicking bladder exstrophy: a case report and literature review. J Med Ultrason (2001) 2018; 45:529-533. [PMID: 29318419 DOI: 10.1007/s10396-017-0856-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
A 26-year-old pregnant woman was diagnosed with fetal bladder prolapse following rupture of a patent urachus/urachal cyst, based on the finding of cyst disappearance with replacement with an infra-umbilical, extra-abdominal solid soft-tissue mass, mimicking bladder exstrophy. The neonatal findings confirmed the prenatal diagnosis. The baby was healthy and had a successful surgical correction. This report provides clues to differentiating ruptured bladder prolapse from bladder exstrophy as follows: (1) well-documented urachal cyst with urine-filled mass in the early gestation, (2) development of solid soft-tissue mass shortly after disappearance of the urachal cyst, and (3) no other structural abnormalities (bladder exstrophy is usually associated with abnormal genitalia, epispadias, or pubic diastasis). This study underlines the differentiation between the two entities because of the vast difference in prognosis, management, and proper counseling.
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Affiliation(s)
- Kasemsri Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phitsanu Mahawong
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cholaros Charoenratana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Chen A, Chong J, Si Q, Haines K, Mehrazin R. Robotic approach to resection of villous adenoma of the urachus: a case report and literature review. J Robot Surg 2017; 12:567-570. [PMID: 28889213 DOI: 10.1007/s11701-017-0753-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Very few cases of villous adenomas of the bladder or urinary tract have been described. To our knowledge this is the first account of resection of an urachal villous adenoma via robotic laparoscopy, which is a safe and efficacious surgical approach. At this time, there is not enough evidence to suggest that progression of disease to carcinoma is the typical course. Nonetheless, follow-up cystoscopy is recommended after complete removal of the adenoma to monitor for recurrence. This case report reviews the current literature and describes a novel approach to treatment of this exceedingly rare entity.
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Affiliation(s)
- Annie Chen
- Department of Urology, Albany Medical College, 23 Hackett Blvd, Albany, NY, 12208, USA.
| | - Julio Chong
- Department of Urology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1272, New York, NY, 10029, USA
| | - Quisheng Si
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1194, New York, NY, 10029, USA
| | - Kenneth Haines
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Reza Mehrazin
- Department of Urology, The Icahn School of Medicine at Mount Sinai, 5 East 98th St., 6th Floor, New York, NY, 10029-6574, USA
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41
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Abstract
Diseases of the urachal remnant can present at any age. Urachal adenocarcinoma is the most frequent cause of urachal mass in adults, albeit infected urachal cyst constitutes a significant number. Lack of typical clinical and imaging findings combined with absence of definitive guidelines makes evaluation of urachal mass in adults very challenging. We present a case of a 58-year-old man presenting with an urachal mass with overlapping clinical and imaging findings mimicking urachal malignancy which later turned out to be an infected urachal cyst.
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Affiliation(s)
- Bargavee Venkat
- Department of Radiology and Imaging, Aster CMI Hospital, Bengaluru, India
| | - Sudhir Kale
- Department of Radiology and Imaging, Aster CMI Hospital, Bengaluru, India
| | | | - Girish Govindaiah
- Department of Surgery and Allied Specialities, Aster CMI Hospital, Bengaluru, India
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Shapiro E. Best of the 2016 Society for Pediatric Urology Fall Congress: Highlights From the 2016 Society for Pediatric Urology Fall Congress, September 9-11, 2016, Dallas, TX. Rev Urol 2017; 19:131-133. [PMID: 28959153 PMCID: PMC5610366 DOI: 10.3909/riu0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Ellen Shapiro
- Department of Urology, NYU Langone Medical CenterNew York, NY
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Abstract
Urachal carcinoma is a rare and aggressive form of bladder cancer involving the urachus, a fibrous remnant of the allantois that extends from the bladder to the umbilicus. We report this case of a 49-year-old women with primary urachal adenocarcinoma treated with partial cystectomy who relapsed 5 years after surgery with lung metastases. This patient with unremarkable medical history presented with abdominal discomfort and a palpable pelvic mass. Follow-up imaging reveals a large mass on the dome of the bladder extending from the urachus. Subsequent ultrasound-guided biopsy result was suggestive of an urachal mucinous adenocarcinoma. The patient was treated surgically with a partial cystectomy.
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Affiliation(s)
- Bo Bao
- Department of Radiology, Foothills Medical Center, 1403-29 Street N.W., Calgary, AB T2N 2T9, Canada
| | - Muhammed Hatem
- Department of Radiology, Foothills Medical Center, 1403-29 Street N.W., Calgary, AB T2N 2T9, Canada
| | - Jason K Wong
- Department of Radiology, Foothills Medical Center, 1403-29 Street N.W., Calgary, AB T2N 2T9, Canada
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Thirunavukkarasu B, Mridha AR, Yadav S, Kumar R, Gamanagatti S. Fine Needle Aspiration Cytology Diagnosis of an Urachal Adenocarcinoma. J Clin Diagn Res 2016; 10:ED10-2. [PMID: 27190817 DOI: 10.7860/jcdr/2016/16115.7586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Urachal Carcinoma (UC) is a rare malignancy of urinary bladder. It is usually found in adults in advanced stages because the tumour often grows outside the bladder without producing clinical symptoms. Most of the cases are mucinous, intestinal or signet ring cell adenocarcinoma and the diagnosis is usually made on biopsy. Radiographic images of this tumour may show characteristic features with a midline solid or cystic mass in the anterior wall of bladder associated with small calcification, which is considered as a pathognomonic sign for the diagnosis of UC. We report a case of UC in an adult, whose radiographic images suggested an urachal tumour and Fine Needle Aspiration (FNA) cytology revealed an adenocarcinoma. Laparoscopic partial cystectomy with umbilectomy and pelvic node dissection was done without further histopathological confirmation. Surgical intervention of UC on the basis of FNA diagnosis has not been reported in the literature.
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Affiliation(s)
| | - Asit Ranjan Mridha
- Assistant Professor, Department of Pathology, All India Institute of Medical Sciences , New Delhi, India
| | - Siddharth Yadav
- Postgraduate Student, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Rajeev Kumar
- Professor, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Shivanand Gamanagatti
- Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi, India
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Dhillon J, Liang Y, Kamat AM, Siefker-Radtke A, Dinney CP, Czerniak B, Guo CC. Urachal carcinoma: a pathologic and clinical study of 46 cases. Hum Pathol 2015; 46:1808-14. [PMID: 26364859 DOI: 10.1016/j.humpath.2015.07.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Urachal carcinoma is a rare tumor that has not been well studied. To determine the pathologic and clinical features of this disease, we retrospectively evaluated 46 cases from our surgical pathology files. The patients included 16 women and 30 men, with a mean age of 53.4 years (range, 28-82 years). Forty patients had undergone cystectomy, and the remaining 6 had undergone transurethral bladder biopsy. Most tumors were located at the dome (n = 44); only 2 were located at both the dome and anterior wall. All tumors consisted of adenocarcinoma, including mucinous (n = 36), enteric (n = 7), not otherwise specified (n = 2), and signet ring cell (n = 1) types. Focal areas of signet ring cell features were present in 23 cases, but urothelial carcinoma in situ was not identified in any cases. The tumors invaded the muscularis propria (n = 8), perivesical adipose tissue (n = 27), and abdominal wall (n = 3). Twenty-five patients had died of cancer at a mean of 32 months (range, 12-74 months), and 21 patients were alive at a mean of 65 months (range, 7-230 months). The median cancer-specific survival time of urachal adenocarcinoma patients was 45 months, which was significantly longer than that of bladder urothelial carcinoma patients with similar-stage disease (P = .047). Patients' cancer-specific survival was associated with tumor stage according to the Sheldon, Mayo, and TNM staging systems. In conclusion, urachal carcinomas are predominantly composed of invasive adenocarcinomas, which commonly demonstrate mucinous features. Most tumors present at advanced stages but are still associated with a better survival rate than bladder urothelial carcinomas.
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Affiliation(s)
- Jasreman Dhillon
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030; Department of Pathology, Moffitt Cancer Center, Tampa, FL 33612
| | - Yu Liang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Arlene Siefker-Radtke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Colin P Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Bogdan Czerniak
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.
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Cheikhelard A, Irtan S, Orbach D, Minard-Colin V, Rod J, Martelli H, Sarnacki S. Urachal rhabdomyosarcoma in childhood: a rare entity with a poor outcome. J Pediatr Surg 2015; 50:1329-33. [PMID: 25913896 DOI: 10.1016/j.jpedsurg.2014.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 12/25/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma (RMS) of the urachus is rare and gathered in the "abdominal and other locations" group for oncological treatment purpose, and therefore not well characterized. Our aim was to assess the clinical and prognostic specific features of urachal primary RMS in childhood. METHODS We retrospectively reviewed the charts of 8 patients with an urachal RMS treated between 1984 and 2013 in two Pediatric Oncology Departments. Median follow-up was 42 months (18-100). RESULTS Urachal RMSs were embryonal in 6, alveolar in 1, and not otherwise specified in 1. Age at diagnosis was 4.4 years (2.6-6). All patients had advanced locoregional extension (IRS IIIIV) and 1 had distant metastasis. All had chemotherapy and surgical resection. Six had external radiotherapy. Four had extensive peritoneal recurrence including 2 with distant metastasis, within a median of 25 months (11-82) after the end of treatment. One had metastatic progression under primary treatment. Four of them died between 18 and 57 months after diagnosis, and 1 is still under treatment for a late recurrence. Only 3 are free of disease after 3.3 to 7.9 years of follow-up. CONCLUSIONS Pediatric urachal cancer is rare and poorly identified. In our series, RMS was exclusive in this location. Locoregional extension was always advanced. Prognosis was poor despite current multimodal therapy. We underline the need for new therapeutical strategies.
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Affiliation(s)
- Alaa Cheikhelard
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France.
| | - Sabine Irtan
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France
| | - Daniel Orbach
- Pediatric and Adolescent Oncology Department, Institut Curie, Paris, France
| | - Véronique Minard-Colin
- Pediatric and Adolescent Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Julien Rod
- Pediatric Surgery Department, CHU de Caen and Universite de Caen Basse-Normandie, Medical School, Caen, France
| | - Hélène Martelli
- Pediatric Surgery Department, AP-HP, Hopital Bicetre, Le Kremlin-Bicetre, France; HUPS, Universite Paris-Sud, Le Kremlin-Bicetre, France
| | - Sabine Sarnacki
- Pediatric Surgery and Urology Department, AP-HP, Hopital Necker, Paris, France; Universite Paris Descartes, Sorbonne Paris Cite, Paris, France
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Stopak JK, Azarow KS, Abdessalam SF, Raynor SC, Perry DA, Cusick RA. Trends in surgical management of urachal anomalies. J Pediatr Surg 2015; 50:1334-7. [PMID: 26227313 DOI: 10.1016/j.jpedsurg.2015.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE We have noted an increasing frequency of diagnosed urachal anomalies. The purpose of this study is to evaluate this increase, as well as the outcomes of management at our institution over 10 years. METHODS A retrospective analysis of urachal anomalies at our institution was performed. Inclusion criteria were Anomalies of Urachus (ICD 753.7) or Urinary Anomaly NOS (ICD 753.9) between January 2000 and December 2010. Exclusion criteria were having an asymptomatic urachal remnant incidentally excised. RESULTS Eighty-five patients (49 male, 36 female) presented between 0 and 17 years of age (mean 1.5 years). Diagnoses increased from 0 in 2000 to 21 in 2010. Zero was surgically managed in 2000 while 21 were managed in 2010 (p=0.0145). Fifteen patients (17.6%) were observed with 13 (13/15, or 15.3%) resolving without complication while 2 were operated on. Average time to resolution (clinical or radiologic) was 4.9 months (Range: 0.4-12.6). A total of seventy-two patients (84.7%) underwent excision. Thirty-nine (54%) surgical cases were outpatient while 33 (46%) were admitted. Thirteen (18%) had post-operative complications. Ten (77%) of the complications were wound infections. Patients under 6 months of age accounted for 60% (6 of 10) of all wound infections and 52% (17 of 33) of hospitalizations. CONCLUSIONS Our experience and review of the literature suggest a high complication rate with surgical management in young patients, mostly from infections and support non-operative management of all non-infected urachal remnants in children.
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Affiliation(s)
- Joshua K Stopak
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Kenneth S Azarow
- Department of Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Shahab F Abdessalam
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Stephen C Raynor
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
| | - Deborah A Perry
- Department of Pathology, Children's Hospital & Medical Center, Omaha, NE, 68114, USA
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE, 68114-4113, USA
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Abstract
Abnormalities in the closure of the intraembryonic portion of the allatoic lumen result in urachal abnormalities. Urachal remnant diseases are rare in adults. Malignant urachal neoplasms, like adenocarcinoma which may probably occur due to metaplasia of the transitional epithelium of the urachal remnant are very rare. Surgical excision of the urachus is needed. The imaging features of the urachal abnormalities are important for correct diagnosis and surgical management.
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Affiliation(s)
- Sunkeswari Sreepadma
- Assistant Professor, Department of Anatomy, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | | | - Jaideep Ratkal
- Consultant Surgeon, Lifeline Hospital, Hubli, Karnataka, India
| | - Veena Kulkarni
- Professor, Department of Anatomy, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Rajeev Joshi
- Consultant Physician, Lifeline Hospital, Hubli, Karnataka, India
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Abstract
Diseases of urachal remnants are uncommon and generally located on the junction of the urachal remnant with the bladder dome. In most cases such diseases correspond to mucinous adenocarcinomas and present hematuria as their most common clinical finding. The authors report the case of a 62-year-old female patient undergoing follow-up due to macroscopic hematuria for three years. Ultrasonography and computed tomography findings are described.
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Affiliation(s)
- Célio Lúcio Palha da Cruz
- MDs, Residents of Radiology and Imaging Diagnosis, Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brazil
| | - Gabriel Lacerda Fernandes
- MDs, Residents of Radiology and Imaging Diagnosis, Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brazil
| | - Marcelo Ricardo Canuto Natal
- MD, Radiologist, Medical Residency Coordinator (Radiology and Imaging Diagnosis), Hospital de Base do Distrito Federal (HBDF), Radiologist at Diagnóstico das Américas (DASA/Exame-Pasteur), Brasília, DF, Brazil
| | | | - Patrícia Amaral Bicalho
- Medical Practice Resident Physician, Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brazil
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Anand M, Deshmukh SD, Gulati HK, Ladkat SS, Jadhav SE, Purandare SN. Angiomatous leiomyoma of the urachus: A rare entity masquerading as extraluminal gastrointestinal stromal tumor. Urol Ann 2013; 5:200-3. [PMID: 24049386 PMCID: PMC3764904 DOI: 10.4103/0974-7796.115752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/18/2011] [Indexed: 11/17/2022] Open
Abstract
The urachus is a vestigial structure located between the dome of the bladder and the umbilicus, which results from the involution of the allantoic duct and the cloaca. Persistence of an embryonic urachal remnant can cause various problems during childhood and young adulthood. Urachal leiomyoma is a rare entity with very few cases being reported in literature. It can be misdiagnosed and confused with a wide spectrum of intra-abdominal or pelvic disorders. We hereby report a case of angiomatous leiomyoma originating from the urachal remnant in a 45-year-old lady, masquerading as extraluminal gastrointestinal stromal tumor. Understanding the embryological basis of these urachal disorders and their imaging features coupled with histopathological examination is crucial for the correct diagnosis and management. Pathological diagnosis is required to optimize the surgical approach and preclude unnecessary radical surgery.
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Affiliation(s)
- Mani Anand
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
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