During a period of fifteen years, 9 children and 5 adults with a varie
ty of urachal anomalies were treated. Infected urachal cysts were more
common in children whereas adults more frequently had infected uracha
l sinuses. After careful physical examination, a preoperative diagnosi
s could be made in most patients, with ultrasound examination decisive
in doubtful cases. Whenever feasible, complete excision of the umbili
covesical tract is performed, but in very ill patients, a staged treat
ment becomes necessary. The preoperative injection of methylene blue i
s helpful in the identification of communicating tracts, all of which
should be removed. All affected children should undergo investigation
for associated genitourinary anomalies.