Patent Urachus

Prepared by: Justin Ahorro

Urachus

The urachus is a fibrous remnant of the allantois, a canal that drains the urinary
bladder of the fetus that joins and runs within the umbilical cord. The fibrous
remnant lies in the space of Retzius, between the transversalis fascia anteriorly and
the peritoneum posteriorly.

Formation

The vesico-urethral portion of the urogenital sinus absorbs the ends of the Wolffian
ducts and the associated ends of the renal diverticula, and these give rise to the
trigone of the bladder and part of the prostatic urethra. The remainder of the
vesico-urethral portion forms the body of the bladder and part of the prostatic
urethra; its apex is prolonged to the umbilicus as a narrow canal, which later is
obliterated as the urachus goes on to definitively form the median umbilical
ligament (urachus). Note: The two medial umbilical ligaments are the
obliterated umbilical arteries.

Pathology

Failure for the lumen of the urachus to be filled in leaves a patent (open) urachus.
The telltale sign is leakage of urine through the umbilicus. A patent urachus needs
to be surgically removed. There are four anatomical cases

• Urachal cyst: there is no connection between the bladder and the umbilicus
• Urachal fistula: there is free communication between the bladder and
umbilicus
• Urachal diverticulum [Vesicourachal diverticulum]: the bladder exhibits
outpouching
• Urachal sinus: the pouch opens toward the umbilicus

Patent urachus repair

Patent urachus repair is surgery to repair a bladder defect. In an open (or patent)
urachus, there is an opening between the bladder and the umbilicus that should not
be there. An open urachus occurs mostly in infants.
Description

Children who have this surgery will receive general anesthesia.

The surgeon will make an incision in the lower belly. Next the surgeon will locate
the urachal tube and remove it. The bladder opening will be repaired, and the
incision will be closed.

The surgery can also be done with a laparoscope. The surgeon will make three small
incisions in the child’s belly. The surgeon will insert the laparoscope through one of
these incisions and other tools through the other cuts.

• The surgeon uses the tools to remove the urachal tube and close off the
bladder and area where the tube connects to the umbilicus.

This surgery can be done in children as young as 6 months.

Why the Procedure is Performed

Surgery is recommended for a patent urachus that does not close after birth. If the
urachal tube is not removed and closed:

• Your child has a higher risk for urinary tract infections.

• Your child has a higher risk for cancer of the urachal tube later in life.
• The urachus may also continue to leak urine.

Risks

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Infection
• Blood clots in the legs that may travel to the lungs

Additional risks for this surgery are:

• Bladder infection
 • Bladder leaks -- if this happens, a catheter is inserted into the bladder to
drain urine. It is left in place until the bladder heals

Before the Procedure

The surgeon may ask for your child to have:

• Ultrasound of the urachus with a sinogram. In this procedure, a radioactive

dye is injected into the urachal opening.
• Kidney ultrasound
• VCUG (voiding cystourethrogram) a special x-ray to make sure the bladder is
working
• A complete medical history and physical exam

Always tell your child’s doctor or nurse:

• What drugs your child is taking. Include drugs, herbs, vitamins, or any other
supplements you bought without a prescription.
• About any allergies your child may have to medicine, latex, tape, or skin
cleaner.

During the days before the surgery:

• About 10 days before the surgery, you may be asked to stop giving your child
aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), warfarin
(Coumadin), and any other drugs that make it hard for blood to clot.
• Ask the doctor which drugs your child should still take on the day of the
surgery.

On the day of the surgery:

• Your child will probably not be able to drink or eat anything for 4 to 8 hours
before surgery.
• Give your child any drugs the doctor said your child should have with a small
sip of water.
• Your child’s doctor or nurse will tell you when to arrive at the hospital.
• The doctor will make sure your child has no signs of illness before surgery. If
your child is ill, the surgery may be delayed.

After the Procedure

Most children stay in the hospital for just a few days after this surgery. Most recover
rapidly. Children can eat their normal foods once they start eating again.
Before leaving the hospital, the nurse should teach you how to care for the wound
or wounds. If Steri-Strips were used to close the wound, they should be left in place
until they fall off on their own in about a week.

The doctor may give you a prescription for antibiotics to prevent infection and
recommend safe medicine to use for pain.

Outlook (Prognosis)

The outcome is usually excellent.