Presented by: Adib Rahman
Toowoomba hospital

Introduction

The diagnosis and management of urachal pathology remains an area of uncertainty. The decision to excise instead of regular surveillance is made challenging due to a varied clinical presentation, non-standardised investigative approach, and potential malignant transformation of this pathology. The objective of this study is to assess the clinical presentation, diagnosis, therapeutic management, and outcomes of urachal anomalies in our health area.

Materials

We retrospectively compiled data of adult patients reviewed in the Royal Hobart Hospital over a 5-year period between 2017 and 2021. We then conducted a literature review to assess the current recommendations and opinions in urachal pathology to compare to our current practice.

Results

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Between 2017 and 2021 there were seven patients seen with urachal pathologies, five male and two female, aged between 32 and 73. Four were incidentally detected on imaging studies (three CT and one USS) and three presented with various symptoms. Of the symptomatic patients, all presented with recurrent urinary tract infections alongside a combination of lower abdominal pain, haematuria, and subjective fevers. Six patients had a urine MCS completed, with three showing no growth, two samples that were contaminated and one with a mixed growth. All patients had a CT scan, three had an ultrasound and two had an MRI. Furthermore, following imaging, two patients had a biopsy of the lesion. Four patients proceeded to surgical excision of the lesion (one laparoscopic vs three open), and of these there were no immediate surgical complications. One patient chose not to follow up and two remain waiting for an initial cystoscopy. Histologically, one urachal remnant was lined by intestinal epithelium, and one showed a ​​mucinous cystic tumour. This is of interest as both these have malignant potential, albeit low. The remaining were benign urachal remnants.

Conclusion

In keeping with current literature, our series demonstrates the clinical conundrum of the uncommon urachal remnant. Excision of lesions with malignant potential confirms the need for adequate and thorough counselling of patients, and joint decision making around operative versus surveillance approaches. Our data suggests that surgical excision of urachal remnants is a safe option and may lead to the removal of incidentally detected lesions with malignant potential.

Funding

nil

Lead Authors

Kale Munien,
Toowoomba Hospital