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Purpose: It has been suggested that symptomatic UA requires surgical excision. However, the management of asymptomatic urachus is still controversial. We aimed to evaluate the clinical presentation, the efficacy of current modalities used, and postoperative pathology in patients with UA. Material and Methods: We have performed a retrospective review of all patients diagnosed with UA and treated surgically or conservatively over 18 years. Demographic data, clinical presentation, imaging modalities, pathology, treatment, and postoperative complications were analyzed. Results: Twenty-five symptomatic patients (18 males and seven females) with a median age of 13 years (one month to 37 years) were identified. 15 (60%) were diagnosed with a urachal cyst, 4(16%) with sinus, 3(12%) with urachal diverticulum, and the remaining 3(12%) with patent urachus. Of those, 20(80%) underwent surgical repair, and the remaining five (20%) patients were managed conservatively. 4 (20%) underwent laparotomy, 7 (35%) laparoscopic incision, and the remaining 9 (45%) laparoscopic robotic-assisted surgery. Nine patients required bladder cuff excision. The median operative time was 75 minutes (42-140 min). One patient developed Clavien Dindo grade IIIA complication resulting in infected hematoma, which resolved after drainage. Another patient with a complication of grade IIIB needed reoperation as a result of recurrent events of an abscess. 13 (65%) demonstrated epithelium lining of the urachus on postoperative pathology.Conclusions: Our data show that most of the patients with UA presented with epithelial lining, which might lead to the later malignant transformation. It might cause a shift from the conservative management of asymptomatic patients to surgical intervention. Robotic-assisted surgery appears beneficial in these patients, especially when the bladder cuff excision is required.

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.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.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.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.

Urachal adenocarcinomas are rare cancers of the urinary bladder. Both CT and MRI are useful imaging modalities for the diagnosis and evaluation of urachal adenocarcinoma. Unlike CT or MR, there have been variable FDG PET findings with urachal tumours potentially due to considerable variation in their hypermetabolism. We present the case of a 24 year-old female patient who was diagnosed with urachal mucinous adenocarcinoma with characteristic features on CT and MRI which also exhibit moderately increased FDG avidity.

Currently, a significant number of publications have been accumulated on the disorders of urinary duct, urachus involution. However, the world literature data on the timing of obliteration and the frequency of urachal anomalies vary significantly, which makes it difficult to assess the risk of complications. There is also no consensus on the tactics of management of these patients. This paper analyzes 62 medical sources on the issues of urinary duct involution, disorders of its obliteration, clinical manifestations of urethral complications and treatment of related conditions. The article also presents data of our own observations of 37 patients with various urachal pathology over a ten-year observation period, including 21 (56.76%) children had umbilical fistulas, 14 (37.84%) children - urachal cysts, 2 (5.4%) patients - bladder diverticula. The data of diagnosis and treatment of children with this pathology are presented.Purpose: analysis of medical sources and own data on the diagnosis and treatment of urinary duct pathology in children, highlighting important and practically significant recommendations on problematic issues of this pathology.Conclusions.1. Urachus is an embryonic formation that connects the bladder with the allantois. According to pathological and anatomical studies, impaired obliteration of the urinary duct occurs in approximately 30% of cases.2. The presence of discharge from the umbilicus, recurrent omphalitis, the presence of a tumor-like mass of the anterior abdominal wall, symptoms of urinary tract infection should be indications for targeted examination for possible urethral pathology.3. The main methods of diagnosing the pathology of the urinary duct are ultrasound and fistulography.4. Data on the age involution of urachus, which occurs in the postnatal period, determine the need to choose the treatment tactics in childhood., На сьогодні накопичена значна кількість публікацій, що присвячені порушенням інволюції сечової протоки – урахусу. Тим не менш дані світової літератури стосовно термінів облітерації і частоти аномалій урахусу значно відрізняються, що утруднює оцінку ризиків виникнення ускладнень. Також немає єдиної думки віднос-но тактики ведення цих пацієнтів. У даній роботі проаналізовані 62 медичних джерела з питань інволюції сечової протоки, порушення її облітерації, клінічних проявів ускладнень урахусу та лікування пов’язаних з цим станів. У статті також наведені дані власних спостережень за 37 пацієнтами з різноманітною патологією урахусу за десятирічний період спостереження, серед яких: 21 (56,76%) дитина мала пупкові нориці, 14 (37,84%) дітей – кісти ураху-су, 2 (5,4%) пацієнтів – дивертикули сечового міхура. Висвітлені дані діагностики та лікування дітей з цією патологією. Аналіз медичних джерел та власних спостережень з питань діагностики і лікування патології сечової протоки у дітей надали змогу висвітлення важливих і практично значимих рекомендацій з про-блемних питань даної патології.Висновки1. Урахус є ембріональним утворенням, що з’єднує сечовий міхур з алантоісом. За даними патологоанато-мічних досліджень порушення облітерації сечової протоки відбувається приблизно у 30% випадків.2. Наявність виділень з пупка, рецидивуючий омфаліт, наявність пухлиноподібного утворення передньої черевної стінки, симптоми інфекції сечовидільних шляхів мають бути показами до прицільного обстеження відносно можливої патології урахусу.3. Основними методами діагностики патології сечової протоки є УЗД та фістулографія.4. Дані про вікову інволюцію урахуса, що відбувається в постнатальному періоді, диктують необхідність вибору лікувальної тактики в дитячому віці.

Relatively little is known about allantois and urachal development in early humans. Serial sagittal histological sections from eight human embryos and fetuses were examined to determine allantois development. At gestational age 6-7 weeks, the primitive allantois consists of an enlarged tube located between the umbilical cord and abdominal cavity, whereas the urachus is not yet developed. At 8 weeks, the allantois gradually withdraws from the distal to the proximal end of the umbilical cord, and both the proximal allantois and the rectum (hindgut) start to develop into the cloaca. At 10 weeks, the allantois was located mostly in the abdominal cavity. The urachus forms from the distal end of the allantois and develops into a closed fibrous cord between the base of the urinary bladder and the umbilicus. The urogenital sinus forms from the proximal end of the allantois.

To explore the extraperitoneal laparoscopic urachal mass excision technique and its safety and efficacy in treating urachal mass.Baseline characteristics were collected from patients who underwent surgery to diagnose a urachal cyst or abscess in our hospital between January 2020 and August 2021. The full-length of the urachus and part of the top bladder wall were completely removed through the extraperitoneal approach. Patient outcomes were collected to evaluate surgical safety and efficacy, including operation time, intraoperative blood loss, drainage tube removal time, length of stay (LOS), and postoperative complications.All 20 surgeries were successfully performed laparoscopically, and no case was converted to open surgery. The mean body mass index of the patients was 24.6 ± 2.2. The mean patient age was 49.3 ± 8.7 years. The mean size of the cysts was 3.0 ± 0.4 cm. The mean operation time was 56.3 ± 12.0 min. The mean intraoperative blood loss was 28.0 ± 6.4 mL. The mean drainage tube removal time was 3.0 ± 0.5 days. The mean LOS was 5.2 ± 0.4 days. The mean follow-up was 13.4 ± 2.1 months. No postoperative complications were observed during the follow-up period. The short-term follow-up and small patient cohort limited our outcome evaluation.Our results indicated that the extraperitoneal laparoscopic approach was a safe and effective method to treat urachal mass. Given the limitations of the study, further multiple and larger sample-sized trials are required to confirm our findings.

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

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

Taras Hladun,1 Jakub Ratajczak,1 Maciej Salagierski2 1Urology Department, Regional Specialized Hospital in Nowa Sól, Nowa Sól, 67-100, Poland; 2Department of Urology, Collegium Medicum, University of Zielona Góra, Zielona Góra, 65-046, PolandCorrespondence: Maciej SalagierskiDepartment of Urology, Collegium Medicum, University of Zielona Góra, Zyty 26, Zielona Góra, 65-046, PolandTel +48 504 174 253Email m.salagierski@cm.uz.zgora.plAbstract: This report presents the case of a rare and aggressive cancer originating from the urachus in a 73-year-old female. After 12 years of observation due to a cystic lesion in the bladder dome, the patient rapidly developed haematuria and mucinuria. The use of multiple diagnostic measures suggested urachal malignancy. Partial cystectomy and urachal excision along with pelvic lymphadenectomy were performed. Urachal adenocarcinoma with negative surgical margins and lymph nodes was reported in pathology. Follow-up after 12 months did not reveal any cancer relapse. Epidemiological, clinical and therapeutic features of this disease are also discussed.Keywords: urachus, adenocarcinoma, haematuria, mucinuria, cystectomy

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

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

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

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

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

Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.

Urachus is a tubular connection between the umbilical cord and the bladder of developing foetus and tends to degenerate during perinatal period to form an impatent median umbilical ligament. Failure to degenerate results in patent canal between the bladder and the umbilicus called "patent urachus" which may lead to serious of symptoms such as umbilical discharge, dermatitis, umbilical infection, abdominal pain or recurrent urinary tract infections. The Tenckhoff catheter is a tube used to perform peritoneal dialysis that is inserted through abdominal wall into peritoneum either by open surgery, minilaparotomy, laparoscopy or needle-guidewire technique.A 57-years old man was admitted to the hospital after implantation of Tenckhoff catheter by percutaneous technique in order to start peritoneal dialysis treatment. His medical history was: endstage chronic kidney disease (diabetic nephropathy), type 2 diabetes and hypertension. After the infusion of dialysate the patient experienced sudden urine pressure and passed significant amount of urine. The CT scan showed the tip of catheter being placed inside the urinary bladder. The catheter was introduced through the abdominal wall into the canal of previously undiagnosed patent urachus. The decision about re-surgery was made to stitch urachal remnants and place new the Tenckhoff catheter. Awaiting the surgery patient temporary started hemodialysis. In ongoing observation patient did not present any complications associated with peritoneal dialysis treatment.

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.

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

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

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

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

The urachus is a remnant of the allantois. Failure to obliterate can result in one of four anomalies, urachal cyst being most common. Urachal cysts are relatively rare, especially in adults. This paper presents a patient with an umbilical hernia and a ruptured urachal cyst. A 39-year-old male presented with concern for umbilical hernia, but he also noted drainage. Computed tomography scan showed a urachal cyst and umbilical hernia. The urachal cyst was excised and umbilical hernia closed primarily. The incidence of an urachal cyst is unknown, but persists in roughly 2% of adults. Diagnosis is with ultrasound or CT scan. Management is excision due to risk of urachal carcinoma, which is present in over 50% of specimens. Review of literature did not reveal any other cases of a patient with both an urachal cyst and an umbilical hernia, thus making this case a unique presentation for this condition.

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

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

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

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

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

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

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

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

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

Background: Urachal carcinoma accounts for

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

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

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

No standard procedure has been established for laparoendoscopic single-site surgery for urachal remnants (LESS-U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single-site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS).Fifty-five patients (median age, 27 years; range, 15-69 years) who underwent LESS-U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS-U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self-administered questionnaires (body image and photo-series questionnaire).spLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo-series questionnaires. No patient developed major complications; there was no recurrence in either group.spLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.

A patent urachus is a rare congenital anomaly that atypically presents as an umbilical cord cyst or large umbilical cord. Here we describe a case of a giant umbilical cord cyst in a newborn diagnosed as a patent urachus.A male infant with a birth weight of 3260 g was transferred because of an antenatally diagnosed giant umbilical cord cyst accompanied by yellowish discharge and granulation in the umbilical cord after birth.Patent urachus.The patent urachus was treated by excision of the urachal remnant followed by partial cystectomy.Postoperative orchitis with pyocele occurred and was treated with a course of antimicrobial therapy; and no other complications developed.Newborns with a giant umbilical cord or umbilical cord cysts should be examined for possible accompanying urachal anomalies, even if antenatal ultrasound shows no other suspicious findings, to prevent delayed diagnosis and subsequent complications.

Eine retrospektive Datenanalyse der Urachusoperationen von 2009- 2019 an der Kinderchirurgischen Klinik des Universitätsklinikums in Würzburg. Es zeigte sich, dass der Urachus häufiger als gedacht vorkommt und dies oft als intraoperativer Zufallsbefund., A retrospective data analysis of urachus surgeries from 2009- 2019 at the Pediatric Surgical Clinic of the University Hospital in Würzburg. It was shown that the urachus occurs more frequently than thought and often as an intraoperative incidental finding.

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

The urachal cyst, a remnant of allantois sac during embryogenesis, is a rare condition in adulthood. Urachus is an embryologic remnant degenerating after birth. Abberrant obliteration of the urachus causes urachal abnormalities. The urachal cysts are almost always symptomatic when infected. The symptoms include fever, abdominal pain, tenderness, lower abdominal mass, nausea, vomiting, and dysuria. Ultrasonography, computerised tomography, and magnetic resonance imaging techniques may be insufficient for diagnosis. In most cases, staphylococcus species are isolated from cultures of urachal cysts. Other microorganisms such as Escherichia coli, Enterococcus faecium, Klebsiella pneumonia, and rarely actinomyces may be isolated. Actinomyces, an anaerobic gram-positive filamentous bacterium, is a rare cause of granulomatous disease. In this case report, a 56-year woman with urachal cyst infection with actinomyces is discussed according to current knowledge. https://doi.org/10.29271/jcpsp.2022.05.668

Despite low prevalence in the population, urachus tumors are of clinical interest because some of them may be malignant with a high degree of aggression. The most common malignant tumor of urachus is mucinous adenocarcinoma (MA). In the absence of reliable MA biomarkers, careful evaluation of clinical data is essential to determine the risk of its presence and radical treatment. The objective: a comparative analysis of complaints, symptoms, instrumental / imaging data and treatment results in patients with MA and benign tumor of the urachus. Materials and methods. We report three clinical cases of urachus tumors (2 malignant and 1 benign), which were detected among patients of the Institute of Urology of the National Academy of Medical Sciences of Ukraine for the period from 2016 to 2020. Standard preoperative examination of patients included: collection of complaints, medical history, physical examination (including palpation of the abdomen in the umbilical and hypogastral areas), general clinical laboratory tests, ultrasound, urethrocystoscopy with TUR biopsy (2 patients), imaging (CT in 2, MRI in 1). All patients underwent surgical treatment: laparoscopic removal of urachus with resection of the bladder within the “healthy tissues”. The postoperative follow-up period lasted from 1 to 33 months. Results. In 2 patients (man and woman) according to the results of pathohistological examination of the surgical material was detected MA, in 1 man – leiofibromyoma (LFM). MA was clinically manifested by macrohematuria – 2 (100%) and low back pain – 1 (50%). Pollakiuria and discomfort in the bladder area were observedIn case of LFM. Palpation did not allow to diagnose urachus tumor in any of the patients. On MRI scans, MA was defined as a soft tissue formation with uneven clear contours, with moderate enhancement by contrast, cystic component and calcification, located in the urachus area. On CT scans – as a heterogeneous neoplasm at the apex of the bladder with endo- and exophytic components. Instead, LFM was identified as a soft tissue formation (+34 .. +50 .. +70 units H) with predominantly endophytic growth, which accumulates contrast in the arterial and venous phases. At cystoscopy MA has the form of a papillary neoplasm in the area of the apex of the bladder on the type of “cauliflower”, while LFM has no papillary component. After laparoscopic removal of urachus with wedge-shaped resection of the bladder for a period of 1 to 33 months, cystoscopy did not reveal recurrence of tumors. Conclusions. In the absence of reliable biomarkers, clinical characteristics remain the only “tool” that can predict the risk of MA. Compared with benign tumors of urachus, the characteristic clinical signs of MA are: macrohematuria, exophytic growth, the appearance of “cauliflower” on cystoscopy, the presence of calcifications and cysts in the structure. Even with high aggression potential of MA (low-grade tumors), laparoscopic removal of urachus with resection of the bladder within the “healthy tissues” at an early stage can provide a fairly long recurrence-free period (up to 33 months). Further research is needed to develop MA biomarkers., Несмотря на незначительную распространенность в популяции, опухоли урахуса представляют клинический интерес, поскольку часть из них могут быть злокачественными с высокой степенью агрессии. Наиболее частой злокачественной опухолью урахуса является муцинозная аденокарцинома (МА). В условиях отсутствия надежных биомаркеров МА тщательная оценка клинических данных крайне важна для определения риска ее наличия и радикального лечения. Цель исследования: сравнительный анализ жалоб, симптомов, данных иструментальных/визуализирующих методов исследования и результатов лечения пациентов с МА и доброкачественной опухолью урахуса. Материалы и методы. Описано три клинических случая опухолей урахуса (2 злокачественных и 1 доброкачественная), которые были выявлены у пациентов ГУ «Институт урологии НАМН Украины» за период с 2016 по 2020 г. Стандартное предоперационное обследование пациентов включало: сбор жалоб, анамнеза, физикальное обследование (в том числе пальпацию живота в пупочной и надлонной областях), общеклинические лабораторные тесты, УЗИ, уретроцистоскопию с ТУР-биопсией (у 2 пациентов), визуализирующие (КТ – у 2 или МРТ – у 1). Всем пациентам проведено хирургическое лечение: лапароскопическое удаление урахуса с резекцией мочевого пузыря (СМ) в «пределах здоровых тканей». Период послеоперационного наблюдения составил от 1 до 33 мес. Результаты. У 2 пациентов (мужчины и женщины) по результатам патогистологического исследования операционного материала была обнаружена МА, у 1 пациента – лейофибромиома (ЛФМ). МА клинически проявлялась макрогематурией в 2 (100%) и болью в пояснице в 1 (50%) случае. С другой стороны, при ЛФМ отмечались поллакиурия и дискомфорт в области мочевого пузыря. Ни у одного из пациентов пальпация не позволила диагностировать опухоль урахуса. По данным МРТ, МА определялась как мягкотканное образование с неровными четкими контурами, с умеренным усилением при контрастировании, с кистозным компонентом и кальцификацией, расположенное в области урахуса. При КТ – как неоднородное новообразования на верхушке СМ с эндо- и экзофитным компонентами. При этом ЛФМ идентифицировалась как мягкотканое образование (+34 .. + 50 .. + 70 ед. Н) с преимущественно эндофитным ростом, накапливающее контраст в артериальную и венозную фазы. При цистоскопии МА имеет вид папиллярного новообразования в области верхушки мочевого пузыря по типу «цветной капусты», тогда как ЛФМ не имеет папиллярного компонента. После проведения лапароскопического удаления урахуса с клиновидной резекцией СМ в период от 1 до 33 мес цистоскопия не выявила рецидивов опухолей. Заключение. При отсутствии надежных биомаркеров, клинические характеристики остаются единственным «инструментом», что позволит прогнозировать риск МА. По сравнению с доброкачественными опухолями урахуса, характерными клиническими признаками МА являются: макрогематурия, экзофитный характер роста, вид «цветной капусты» при цистоскопии, наличие кальцификатов и кист в структуре. Даже в условиях высокого потенциала агрессии МА (низкодифференцированные опухоли), лапароскопическое удаление урахуса с резекцией мочевого пузыря в «пределах здоровых тканей» на ранней стадии позволяет обеспечить достаточно длительный безрецидивный период (до 33 мес). Необходимы дальнейшие исследования, которые позволят разработать биомаркеры МА и проводить раннюю диагностику., Попри незначну поширеність у популяції, пухлини урахуса представляють клінічний інтерес, оскільки деякі з них можуть бути злоякісними з високим ступенем агресії. Найчастішою злоякісною пухлиною урахуса є муцинозна аденокарцинома (МА). В умовах відсутності надійних біомаркерів МА ретельна оцінка клінічних даних вкрай важлива для визначення ризику її наявності та радикального лікування. Мета дослідження: порівняльний аналіз скарг, симптомів, даних інструментальних / візуалізуючих методів дослідження та результатів лікування у пацієнтів з МА та доброякісною пухлиною урахуса. Матеріали та методи. Описано три клінічні випадки пухлин урахуса (2 злоякісних і 1 доброякісна), що були виявлені у пацієнтів ДУ «Інститут урології НАМН України» за період з 2016 р. до 2020 р. Стандартне передопераційне обстеження пацієнтів включало: збір скарг, анамнезу, фізікальне обстеження (зокрема пальпацію живота в пупочній та надлонній ділянках), загальноклінічні лабораторні тести, УЗД, уретроцистоскопію з ТУР-біопсією (у 2 пацієнтів), візуалізуючі (КТ – у 2, МРТ – в 1). Усім пацієнтам проведено хірургічне лікування: лапароскопічне видалення урахуса з резекцією сечового міхура (СМ) у «межах здорових тканин». Період післяопераційного спостереження тривав від 1 до 33 міс. Результати. У 2 пацієнтів (чоловіка та жінки) за результатами патогістологічного дослідження операційного матеріалу була виявлена МА, в 1 чоловіка – лейофіброміома (ЛФМ). МА клінічно проявлялася макрогематурією в 2 (100%) і болем у попереку в 1 (50%) випадку. Насамперед при ЛФМ спостерігали полакіурію та дискомфорт у ділянці сечового міхура. У жодного з пацієнтів пальпація не дозволила діагностувати пухлину урахуса. За даними МРТ, МА визначалася як м’якотканинне утворення з нерівними чіткими контурами, з помірним підсиленням при контрастуванні, кістозним компонентом та кальцифікацією, розташоване в ділянці урахуса. При КТ – як неоднорідне новоутворення на верхівці СМ з ендо- та екзофітним компонентами. Натомість ЛФМ ідентифікувалася як м’якотканинне утворення (+34.. +50.. +70 од. Н) з переважно ендофітним ростом, що накопичує контраст в артеріальну і венозну фази. При цистоскопії МА має вигляд папілярного новоутворення в ділянці верхівки сечового міхура за типом «кольорової капусти», тоді як ЛФМ не має папілярного компоненту. Після проведення лапароскопічного видалення урахуса з клиноподібною резекцією СМ за період від 1 до 33 міс цистоскопія не виявила рецидивів пухлин. Заключення. За відсутності надійних біомаркерів клінічні характеристики залишаються єдиним «інструментом», що дозволяє прогнозувати ризик МА. Порівняно з доброякісними пухлинами урахуса, характерними клінічними ознаками МА є: макрогематурія, екзофітний характер росту, вигляд «кольорової капусти» при цистоскопії, наявність кальцифікатів та кіст у структурі. Навіть за умов високого потенціалу агресії МА (низькодиференційовані пухлини), лапароскопічне видалення урахуса з резекцією сечового міхура в «межах здорових тканин» на ранній стадії дозволяє забезпечити досить тривалий безрецидивний період (до 33 міс). Необхідні подальші дослідження, що дозволять розробити біомаркери МА.

Despite low prevalence in the population, urachus tumors are of clinical interest because some of them may be malignant with a high degree of aggression. The most common malignant tumor of urachus is mucinous adenocarcinoma (MA). In the absence of reliable MA biomarkers, careful evaluation of clinical data is essential to determine the risk of its presence and radical treatment. The objective:a comparative analysis of complaints, symptoms, instrumental / imaging data and treatment results in patients with MA and benign tumor of the urachus. Materials and methods.We report three clinical cases of urachus tumors (2 malignant and 1 benign), which were detected among patients of the Institute of Urology of the National Academy of Medical Sciences of Ukraine for the period from 2016 to 2020. Standard preoperative examination of patients included: collection of complaints, medical history, physical examination (including palpation of the abdomen in the umbilical and hypogastral areas), general clinical laboratory tests, ultrasound, urethrocystoscopy with TUR biopsy (2 patients), imaging (CT in 2, MRI in 1). All patients underwent surgical treatment: laparoscopic removal of urachus with resection of the bladder within the “healthy tissues”. The postoperative follow-up period lasted from 1 to 33 months. Results.In 2 patients (man and woman) according to the results of pathohistological examination of the surgical material was detected MA, in 1 man – leiofibromyoma (LFM). MA was clinically manifested by macrohematuria – 2 (100%) and low back pain – 1 (50%). Pollakiuria and discomfort in the bladder area were observedIn case of LFM. Palpation did not allow to diagnose urachus tumor in any of the patients. On MRI scans, MA was defined as a soft tissue formation with uneven clear contours, with moderate enhancement by contrast, cystic component and calcification, located in the urachus area. On CT scans – as a heterogeneous neoplasm at the apex of the bladder with endo- and exophytic components. Instead, LFM was identified as a soft tissue formation (+34 .. +50 .. +70 units H) with predominantly endophytic growth, which accumulates contrast in the arterial and venous phases. At cystoscopy MA has the form of a papillary neoplasm in the area of the apex of the bladder on the type of “cauliflower”, while LFM has no papillary component. After laparoscopic removal of urachus with wedge-shaped resection of the bladder for a period of 1 to 33 months, cystoscopy did not reveal recurrence of tumors. Conclusions.In the absence of reliable biomarkers, clinical characteristics remain the only “tool” that can predict the risk of MA. Compared with benign tumors of urachus, the characteristic clinical signs of MA are: macrohematuria, exophytic growth, the appearance of “cauliflower” on cystoscopy, the presence of calcifications and cysts in the structure. Even with high aggression potential of MA (low-grade tumors), laparoscopic removal of urachus with resection of the bladder within the “healthy tissues” at an early stage can provide a fairly long recurrence-free period (up to 33 months). Further research is needed to develop MA biomarkers.

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.

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

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

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

Urachal patency is an umbilical disease in newborn foals. Etiologically, either the closure of the urachus remains absent after birth (persistent urachus) or the urachus was already closed and reopens at a later time (patent urachus). The most common causes of patent urachus are congenital defects, tearing of the navel above the predilection site, trauma, increased intravesical or abdominal pressure and umbilical infections. Patent urachus occurs more frequently in premature or weak and immunocompromised foals. Colts are more often affected than fillies. Typical clinical signs are apparent immediately after birth (persistent urachus) or 7-14 days postpartum (patent urachus). These include either dripping or a stream of urine through umbilicus during micturition as well as a moist umbilical area. The diagnosis is usually unambiguous. Typical laboratory findings are not described for patent urachus. Conservative treatment such as obliteration, cauterization or cryosurgery may be employed in cases lacking an inflammation of the urachus or other umbilical structures and when the urachal lumen measures less than 6 mm. Surgical treatment is indicated in foals with large urachal lumen, an umbilical infection or sepsis as well as when no therapeutic success is attained after a conservative treatment of 5-7 days. In most cases, prognosis is good, however complications such as umbilical inflammation, disseminating infections, and secondary joint diseases may significantly impair prognosis.Die Urachusfistel ist eine Nabelerkrankung des neugeborenen Fohlens. Ätiologisch bleibt entweder der Schluss des Urachus nach der Geburt aus (Urachus persistens) oder der Urachus war bereits geschlossen und öffnet sich zu einem späteren Zeitpunkt wieder (Urachus patens). Häufige Ursachen für eine Urachusfistel sind kongenitale Defekte, das Abreißen des Nabelstrangs oberhalb der Prädilektionsstelle, Traumata, erhöhter intravesikaler oder abdominaler Druck und Nabelinfektionen. Die Urachusfistel wird des Öfteren bei prämaturen oder lebens- und immunschwachen Fohlen beobachtet. Hengstfohlen sind häufiger betroffen als Stutfohlen. Erkrankte Fohlen zeigen entweder direkt nach der Geburt (Urachus persistens) oder meist 7–14 Tage post natum (Urachus patens) typische klinische Symptome wie Harnträufeln während der natürlichen Miktion oder Harnabsatz im Strahl über den Hautnabel sowie eine feuchte Nabelumgebung. Die Diagnose lässt sich i. d. R. eindeutig stellen. Typische labordiagnostische Befunde sind für die Urachusfistel nicht beschrieben. Konservative Therapieversuche mittels Verödung, Kauterisation oder Kryochirurgie können erfolgen, solange keine entzündlichen Veränderungen des Urachus und der übrigen Nabelstrukturen vorliegen und das Urachuslumen bis zu 6 mm beträgt. Eine Nabelresektion ist dann indiziert, wenn ein sehr weites Urachuslumen, eine begleitende Nabelinfektion oder eine Sepsis vorliegt oder wenn sich nach 5–7 Tagen konservativer Behandlungsdauer kein Therapieerfolg einstellt. In den meisten Fällen besteht eine gute Prognose, doch können Komplikationen wie Nabelentzündungen, streuende Infektionen und sekundäre Gelenkerkrankungen die Prognose erheblich verschlechtern.

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