Title

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

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