Urachal anomalies in children: Experience at one institution

Background: The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentations, uniform guidelines for evaluation and treatment are lacking. In an attempt to establish an optimal diagnostic and treatment modality, we report our experience with urachal anomalies at a single institution over a 10-year period. Methods: The records of 20 patients with urachal abnormalities were reviewed. These included 12 males and 8 females with ages from 1 day to 12 years (average, 3 years). The evaluation included symptoms and signs, and results of fistulography, sonography, and voiding cystography. Postoperative conditions were also reviewed. Results: The presenting complaint was umbilical discharge in 14 patients, umbilical discharge with marked umbilical granulation tissue in 2, periumbilical erythema in 3, and abdominal pain in 1. Diagnostic evaluation included fistulography in 5 cases, sonography in 13, and voiding cystourethrography in 3. The 3 variants of urachal anomalies included a patent urachus in 4 patients (20%), urachal sinus in 13 (65%), and an infected urachal cyst in 3 (15%). Treatment consisted of primary excision with a cuff of the bladder in 3, excision with ligation in 1, excision of the sinus in 13, incision and drainage in 3, and secondary excision in 1. There was 1 postoperative wound infection. Conclusion: Diagnosis and treatment of urachal anomalies can be made with certainty if a good physical examination and proper imaging study are performed. Voiding urethrocystography might not be required in view of the fact that none of the patients studied had an associated urinary tract anomaly.