Faculty Collaboration Database

Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg 2005 Dec;40(12):1874-6

Date

12/13/2005

Pubmed ID

16338309

DOI

10.1016/j.jpedsurg.2005.08.029

Scopus ID

2-s2.0-28844489532 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

PURPOSE: Children with a wet, draining, or infected umbilicus are often referred to pediatric surgeons. Unfortunately, uniform guidelines regarding diagnostic imaging are lacking. Historically, the persistence of the urachus was attributed to intrauterine distal urinary obstruction. Today, many surgeons continue to advocate preoperative voiding cystourethrogram (VCUG).

METHODS: Records of children with urachal abnormalities over the past 10 years were reviewed. Demographics, presentation, imaging, genitourinary anomalies, operations, length of stay, and complications were recorded. Statistical evaluation was by descriptive analysis.

RESULTS: Fifty-six children were diagnosed with urachal anomalies. Age at operation was 2.5 years (1 day-13 years). Fifty percent of patients were less than 1 year. Ultrasound was used in 88% of cases. Voiding cystourethrogram (34%) and computed tomography (14%) were also used. Average hospitalization was 1.9 (0-13) days. Thirty-two percent underwent operations as outpatients. Seven percent developed wound infections. Eight children (14%) had genitourinary anomalies. However, no VCUG examination (n = 19) documented an obstructive process.

CONCLUSIONS: The current study represents the largest reported series of symptomatic urachal anomalies in children. Disorders of the urachus are variable in presentation with the diagnosis reliably made by history and ultrasound alone. Further testing, including VCUG, is not warranted, adding additional cost, an invasive procedure, and inconvenience to the child.

Author List

Little DC, Shah SR, St Peter SD, Calkins CM, Murphy JP, Gatti JM, Gittes GK, Sharp RJ, Andrews WS, Holcomb GW 3rd, Ostlie DJ, Snyder CL

Author

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Congenital Abnormalities
Diagnosis, Differential
Diagnostic Tests, Routine
Health Care Costs
Humans
Infant
Infant, Newborn
Male
Preoperative Care
Retrospective Studies
Tomography, X-Ray Computed
Ultrasonography
Urachus
Urethra
Urinary Bladder
Urination