PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.
Abdominal Pain ; Adult ; Age Distribution ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Hernia, Inguinal ; Hernia, Umbilical ; Hirschsprung Disease ; Humans ; Hydronephrosis ; Male ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.
Abdominal Pain ; Adult ; Age Distribution ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Hernia, Inguinal ; Hernia, Umbilical ; Hirschsprung Disease ; Humans ; Hydronephrosis ; Male ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux

PURPOSE: This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection. MATERIALS AND METHODS: One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined. RESULTS: Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38degrees C, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p<0.05). There were significant positive correlations between fever>38.2degrees C and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux. CONCLUSIONS: This study revealed fever>38.2degrees C and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux.
Biological Markers/metabolism ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Fever/etiology ; Humans ; Infant ; Kidney/radionuclide imaging/ultrasonography ; Male ; Predictive Value of Tests ; Radiopharmaceuticals/diagnostic use ; Sensitivity and Specificity ; Technetium Tc 99m Dimercaptosuccinic Acid/diagnostic use ; Urinary Tract Infections/*etiology ; Vesico-Ureteral Reflux/*complications/*diagnosis