Editing Pediatrics: Bladder Anomalies (section)

=== Urachal Anomalies ===
* In a series of 176 patients diagnosed with a urachal anomaly and urachal remnants, children mostly presented with umbilical drainage or on physical examination; of the adults, 66% had hematuria or pain. Surgical treatment in children consisted of simple excision, whereas over 50% of adults required partial or radical cystectomy because of malignancy.
* Imaging possibilities include ultrasound, CT, and VCUG
* Non-resolved urachal remnants should be excised because of the increased risk for later adenocarcinoma formation
* '''Patent urachus (most common,''' 50%)
** '''Suspected in the neonatal period by continuous or intermittent drainage of fluid from the umbilicus'''
** '''[SASP] 50% of radiographically confirmed patent urachus will spontaneously close in the first 6 months of life and observation is warranted'''
** '''If required, treatment is complete excision of the patent urachus, including a bladder cuff'''
* '''Umbilical-urachus sinus''' (15%)
** Manifestation is similar to that of the patent urachus
* '''Urachal cyst''' (30%)
** There is no communication of the cyst with the bladder or umbilicus.
** However, the fluid-filled cyst can drain through the umbilicus or into the bladder intermittently.
** Urachal cysts are found more commonly in the distal part of the urachus and manifest more commonly in adults than in infants or children
** The cyst material consists of desquamated epithelial cells. These cells can become infected; '''staphylococcus aureus has been identified as the most common organism.''' Once infected, urachal cysts can manifest as umbilical abscess formation or bladder infections
** Treatment consists of antibiotics and draining the infected cyst, followed by complete excision of the urachal remnant structures. Conservative treatment with observation is justified in asymptomatic cases because of possible spontaneous resolution
* '''Vesicourachal diverticulum''' (3%)