Trends in surgical management of urachal anomalies

• Published in: Journal of pediatric surgery Vol. 50; no. 8; pp. 1334 - 1337
• Main Authors: Stopak, Joshua K, Azarow, Kenneth S, Abdessalam, Shahab F, Raynor, Stephen C, Perry, Deborah A, Cusick, Robert A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015
• Subjects: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Infection; Male; Nebraska; Non-operative management; Pediatrics; Postoperative Complications; Retrospective Studies; Surgery; Treatment Outcome; Urachal anomalies; Urachus; Urachus - abnormalities; Urachus - surgery; Urogenital Abnormalities - diagnosis; Urogenital Abnormalities - surgery; Urologic Surgical Procedures - trends; Nebraska; Infection; Urachus; Urachal anomalies; Non-operative management
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2015.04.020

Abstract Purpose We have noted an increasing frequency of diagnosed urachal anomalies. The purpose of this study is to evaluate this increase, as well as the outcomes of management at our institution over 10 years. Methods A retrospective analysis of urachal anomalies at our institution was performed. Inclusion criteria were Anomalies of Urachus (ICD 753.7) or Urinary Anomaly NOS (ICD 753.9) between January 2000 and December 2010. Exclusion criteria were having an asymptomatic urachal remnant incidentally excised. Results Eighty-five patients (49 male, 36 female) presented between 0 and 17 years of age (mean 1.5 years). Diagnoses increased from 0 in 2000 to 21 in 2010. Zero was surgically managed in 2000 while 21 were managed in 2010 (p = 0.0145). Fifteen patients (17.6%) were observed with 13 (13/15, or 15.3%) resolving without complication while 2 were operated on. Average time to resolution (clinical or radiologic) was 4.9 months (Range: 0.4–12.6). A total of seventy-two patients (84.7%) underwent excision. Thirty-nine (54%) surgical cases were outpatient while 33 (46%) were admitted. Thirteen (18%) had post-operative complications. Ten (77%) of the complications were wound infections. Patients under 6 months of age accounted for 60% (6 of 10) of all wound infections and 52% (17 of 33) of hospitalizations. Conclusions Our experience and review of the literature suggest a high complication rate with surgical management in young patients, mostly from infections and support non-operative management of all non-infected urachal remnants in children.