URACHAL ANOMALIES - DEFINING THE BEST DIAGNOSTIC MODALITY

Objectives. Urachal abnormalities are uncommon and the literature is p rimarily comprised of case reports. Conclusions regarding the presenta tion and diagnosis of these abnormalities may be elucidated by reviewi ng a large experience. Methods. The records of 45 patients with uracha l abnormalities in the pediatric age group were reviewed from 1970 to 1997. This included 24 boys and 21 girls with an age range from 1 day to 20 years (average 4.0 years). The presenting complaint was periumbi lical discharge in 19 patients (42%), umbilical cyst or mass in 15 (33 %), abdominal or periumbilical pain in 10 (22%), and dysuria in 1 (2%) . The diagnosis consisted of a urachal sinus in 22 children (49%), a u rachal cyst in 16 (36%), and a patent urachus in 7 (15%). Various radi ographic studies were used to establish the diagnosis. Results. Patien ts with a urachal sinus had 16 voiding cystourethrograms performed (on ly 1 diagnostic), 9 sinograms (all diagnostic), 8 ultrasounds (4 diagn ostic), and 1 excretory urogram (normal). Those with a urachal cyst ha d 8 voiding cystourethrograms (1 diagnostic), 5 excretory urograms (al l normal), 4 ultrasounds (all diagnostic), and 1 computed tomography s can (diagnostic). Children with a patent urachus had 2 excretory urogr ams (both diagnostic), 1 voiding cystourethrogram (diagnostic),and 2 u ltrasounds (normal). One baby with a patent urachus was diagnosed pren atally during ultrasound screening. The diagnosis was made by history and physical examination alone in 5 children and at the time of surger y in 1.Treatment consisted of surgical excision of the urachal abnorma lity with a cuff of bladder in 22 children, surgical excision without a bladder cuff in 22, incision and drainage of a urachal cyst (1%), an d laparoscopic excision of a patent urachus with a bladder cuff in ano ther (1%). There were three wound infections postoperatively. None dev eloped any long-term sequelae. Conclusions. The diagnosis of urachal a bnormalities can be made with certainty if a good physical examination and the appropriate radiographic test are performed. A patient who pr esents with periumbilical drainage should have a sinogram performed, w hich should be diagnostic for both a urachal sinus and a patent urachu s. Any child who presents with a periumbilical mass should have an ult rasound performed, which should be diagnostic for a urachal cyst. (C) 1998, Elsevier Science Inc. All rights reserved.