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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.

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.

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.

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

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.

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.