Introduction: Urachal anomalies are rare and their incidence at birth is estimated to be 1 in 5000-8000 live births, with a male to female ratio of 2:1. It causes numerous diagnostic and therapeutic problems to the nonspecific symptoms.
The urachus is an embryologic remmant which is formed by the obliteration of the allantois. The urachal abnormalities ares caused by the defective obliteration of the urachus.
Objetive: Review the pathology of the urachus in our health area, assessing the clinical presentation, diagnostic method and therapeutic management.
Materials and Metodhs: We had been made a retrospective review of all patients diagnosed with a urachal remanent between 2006 and 2018 in our Hospital. The variables included age, gender, presenting symptoms, diagnostic modality, and type of urachal remnant and pathological anatomy. Operative management, and non-operative follow-up were abstracted.
Results: We diagnosed 21 cases of urachal pathology between 2006 and 2018 in our health area. The mean age of presentation was 32 years [0-78 years], with a higher percentage in men (71.4%) compared to women (28.5%) and being diagnosed in 57% of adult cases (older of 18 years).
In 47.1% of the cases it was a chance finding, 23.8% of patients presented with fever and umbilical exudate, 14.2% fever and pain, and 5% of the cases had recurrent abdominal pain, hematuria or umbilical granuloma.
The main diagnostic test used was abdominal ultrasonography (US), used in 38% of the cases, followed by the computed tomography (CT) in 28.5%. The use of US + CT was 14.2%. US + cystography in 4.7%, US + magnetic resonance imagine 4.7%, CT + cystoscopy in 4.7% and fistulography in 4.7%.
They were diagnosed 28.5% of patents urachus, 61.9% of urachal cysts, and 4.7% of adenocarcinoma and urachal diverticulum.
Regarding the therapeutic approach, 23.8% of the patients were treated with laparoscopic resection, 14.2% with open resection, partial cystectomy 9.5%, radical cystectomy 4,76% and conservative managament in 47, 6%.
81.8% of the resected cases were confirmed by pathological anatomy.
Conclusions: Urachal anomalies are a rare pathology, with a complex differential diagnosis due to the non-specific symptoms.
The majority of cases it is a causal finding, being able to opt for a conservative attitude without forgetting the possible risk of malignization or diagnosis of adenocarcinoma in order to indicate a more radical surgical treatment.
