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.

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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?