Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram.
Document Type
Article
Publication Date
12-1-2005
Identifier
DOI: 10.1016/j.jpedsurg.2005.08.029
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.
Journal Title
Journal of pediatric surgery
Volume
40
Issue
12
First Page
1874
Last Page
1876
MeSH Keywords
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
Keywords
Urachus; cystourethrogram; congenital abnormalities
Recommended Citation
Little, D. C., Shah, S. R., St Peter, S. D., Calkins, C. M., Murphy, J. P., Gatti, J. M., Gittes, G. K., Sharp, R. J., Andrews, W. S., Holcomb, G. W., Ostlie, D. J., Snyder, C. L. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. Journal of pediatric surgery 40, 1874-1876 (2005).
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