Urachal Remnants and Anomalies in Children: Rationales of Surgery

Abstract

Objective: Urachal remnants are rare conditions in children with controversial management. Many of them present with complaints; however, the causality between the symptom and the condition is unclear, and a significant proportion of patients are incidentally identified. Meanwhile, indications of the surgical correction are controversial and the best way of surgical approach depends on the attending physician's experience. This study aimed to evaluate the results of surgically corrected urachal conditions in children. Materials and Methods: This study included patients (n=21) who underwent surgery for urachal conditions between 2010 and 2020. Age, presenting symptoms, radiological evaluation, surgical approach, and results, and histological results are retrospectively evaluated. Results: Of the patients, 12 (57%) were boys, and abdominal pain was the most common presenting symptom (43%). The exact anomaly could not be classified in 8 patients, but classified as urachal sinus (n=5), urachal cyst (n=4), patent urachus (n=2), urachal diverticulum (n=1), and neuroblastoma (n=1) in the rest. Patients with umbilical discharge presented significantly younger than patients with abdominal pain or incidentally recognized patients (2.4 +/- 1.2, 7.2 +/- 1.17, and 10.9 +/- 3.1 years, respectively; p<0.05). No operative complication is encountered. Histological examination revealed only 1 malignancy (neuroblastoma, 5%). Conclusion: Urachal anomalies in children are confusing conditions as they are rare, with unclear significance. Major indications of surgery are complications (infection, persisting drainage, or pain) and potential risk of malignant transformation. Surgery can be offered if complicated and the risk of malignancy appears to be low although not zero.