Patent urachus repair





Definition

Patent urachus repair is surgery to correct a urachus (a tube that connects the fetal bladder to the umbilical cord) that fails to close after birth.


Purpose

A patent urachus is an anomaly, and repair is recommended for these defects occurring at birth.


Demographics

The condition occurs three times more often in male infants than in females.

A patent urachus is an abnormal opening from the bladder to the umbilicus, which is retained from fetal life (A). To repair it, an incision is made in the baby's abdomen (B). The patent urachus is removed (C), and the opening to the bladder is closed (D). (Illustration by GGS Inc.)
A patent urachus is an abnormal opening from the bladder to the umbilicus, which is retained from fetal life (A). To repair it, an incision is made in the baby's abdomen (B). The patent urachus is removed (C), and the opening to the bladder is closed (D). (
Illustration by GGS Inc.
)

Description

As fetal development progresses, the urachus, a tube that can measure from 1.2–3.9 in (3–10 cm) long and 0.3–0.4 in (8–10 mm) in diameter, forms, extending from the front dome of the bladder to the umbilicus. Following birth, the tube, adjacent to the umbilical ligaments, closes and itself becomes ligament. Should this closure fail, it may result in several types of urachal remnants. If the urachus remains completely open, it is known as a patent urachus. This type of abnormality makes up 50% of all urachal anomalies.

If the urachus remains open all the way to the bladder, there is the danger that bacteria will enter the bladder through the open tube and cause infection. For this reason, the patent urachus of the infant must be removed.

Diagnosis/Preparation

This anomaly occurs as an isolated event or in association with prune-belly syndrome, in which there is continuous drainage of urine from the umbilicus. If urine freely discharges through the umbilicus, the patent urachus is rarely found. It should be suspected, however, if a local cord is enlarged and affected with edema, or is slow to slough normally. The condition customarily is diagnosed in infants.

The child is given a general anesthetic, after which an incision is made in the lower abdomen.


Aftercare

Surgery for patent urachus repair may require several days' hospitalization, during which infants can be fed as normal.


Risks

Risks are the same as for those patients receiving any anesthesia: a reaction to medication and/or breathing problems. There is also the risk of bladder infection or bladder leaks. In the latter case, a catheter is put in place until the bladder heals.


Normal results

The outcomes of patent urachus repair in infants are excellent, as a rule, and most children recover rapidly.


Morbidity and mortality rates

Patent urachal anomalies do not usually cause significant morbidity or mortality. However, adenocarcinoma has been reported in adults with urachal remnants, presumably from chronic inflammation and infection. Patency is noted in only 2% of adults.

Alternatives

Sometimes more conservative treatment than surgery is advised, with radical excision reserved for persistent or recurring cases. Because the urachus may not completely close at birth, but may close within the first few months of the infant's life, observation may be advised before moving forward with surgery.


Resources

BOOKS

Campbell, Meredith F. and Patrick C. Walsh, eds. Campbell's Urology, 8th ed. Philadephia: W.B. Saunders Company, 2002.

PERIODICALS

Razvi, S., R. Murphy, E. Shlasko, and C. Cunningham-Rundles. "Delayed Separation of the Umbilical Cord Attributable to Urachal Anomalies." NIH/NLM MEDLINE 108, no.2 (August 1, 2001): 493–494.


Nancy McKenzie, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Patent urachus repair is performed by the pediatric surgeon in a hospital setting.

QUESTIONS TO ASK THE DOCTOR



  • Is it advisable to put off surgery during the first few months of the child's life and see if the urachus will close on its own?
  • What effects will surgery have on a newborn?

User Contributions:

Nasreen
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Sep 10, 2006 @ 10:10 am
THANX FOR THE USEFUL ARTICLE WOULD LOVE TO HEAR SOME THING ABOUT THE HABITUAL MISCARRAGE
dasiy bear
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Feb 7, 2007 @ 7:19 pm
I find it interesting evertime I find some new information on urachal andenocacinoma only because there is so little and I need all the information I can get because I have this cancer. I never heard of it ever before and find it most challenging to find out how to survive it. I wish there was more help because I was told there is no cure for it just surgery.
M-
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Feb 13, 2009 @ 5:17 pm
Took 10 years for them to find this in me. The surgery is SOOO not as bad as dealing with it and nobody knowing what was wrong. Was lucky, no cancer here just a lot of pain. Still no information out there about this condition.
huda
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Mar 1, 2009 @ 3:15 pm
Thanks about this article,is there any other alternative to treatment rather than the surgery and what are the possible investigation options for definitive diagnosis?
sarah
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Apr 29, 2009 @ 6:18 pm
I just wanted to say a huge thank you, this page was able to tell me the correct name of what condition my daughter was born with. It would be good it this condition was made more aware of by the doctors. At my local hospital my 12 week scan showed a cyst on the umbilical cord, after repeated scan, offeres of termination I was told everything was fine. When delivered my daughter umbilical cord was 3 times the size it should have been, being rushed to hospital (I had a home birth) the doctors had no idea what was wrong, transfereing to London hospital the doctor immediatley could tell it was urine leaking from the umbilical cord and surgery took place the next morning, my daughter was a day old. She is now just over 2, has a little outy belly button, no different from her sisters and has had no problems at all. Thanks to this site I can now say she was born with patent urachus. Thanks againxx
kirti
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Aug 18, 2010 @ 4:16 pm
Thanks for information. I have question my daughter had patent urachus rapair, but she still having same symptoms she had before. Drainage from umbilical, moist and curst bulid up in umbilical. can you help me what should I do next.
Thanks you
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Feb 5, 2011 @ 1:01 am
Baby, I found this article last night at exactly 11:48 pm... I couldn't sleep :(
It offers great info regarding the patent urachus.
I luv the part that suggests that it may take months after the birth of a child for the belly button to completely seal off ( under ALTERNATIVES)...I will not allow a surgery on my baby any time soon. Also I like the questions it suggests to ask the doctor regarding postponment of the surgery.
Luv u n Kate ;) always & forever
rasheedah
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Jul 13, 2012 @ 3:03 am
what effect does patent urachus have on new borns and how early can they have it?
not saying
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Nov 13, 2012 @ 5:17 pm
I'm 55 years old and this is my diagnosis. I still don't know why the doctors can't figure out why I have something coming out my navel.
alma aslor
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Nov 16, 2013 @ 2:02 am
Why my patent urachus painful sometimes?
Sometimes when i feel that pain i cannot move anymore.

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