“CONGENITAL ANOMALIES OF URACHUS” EMBRYOLOGICAL BASIS AND ITS CLINICAL SIGNIFICANCE (original) (raw)

A study of the anatomic features of the duct of the urachus

Surgical and Radiologic Anatomy, 2001

The urachus is an embryonic remnant resulting from involution of the allantoic duct and the ventral cloaca. Attaching the bladder dome to the umbilicus, this duct becomes progressively obliterated during fetal life. It may subsequently persist as different variants after birth, some regarded as normal, others as pathologic, due to incomplete closure. Six pediatric cases are reported here, and the literature on the embryology and anatomic basis of the duct is discussed. The urachus is present in nearly 100% of children at birth, with several possible shapes tubular, fusiform or funnel. It gradually regresses and is found in only a third of adults. Its length varies from 1 to 15 cm. In our series 6 patients showed defective closure of the duct, including 3 with complete patency, 1 cyst, 1 diverticulum and 1 external sinus. Although rare, congenital pathology of the urachus requires a sound knowledge of the anatomy and embryology to distinguish normal forms from those subject to complications. It should be suspected with any lesion in the umbilical region and the appropriate treatment instituted.

Bladder prolapse through a patent urachus: fetal and neonatal features

Journal of Pediatric Surgery, 2006

We report a term male neonate who was born with a large, red, tubular, mucosa-lined umbilical mass containing a patent lumen. Prenatal ultrasonographic screening at 20 to 28 weeks of gestation revealed a large cyst at the umbilicus, communicating with the urinary bladder. The cyst resolved at 32 weeks, and a small solid mass was newly seen on the fetal abdominal wall, inferior to the umbilical cord insertion. At operation, the mass was discovered to be the prolapsed, open, everted dome of the urinary bladder. The dome was resected, and the bladder was repaired in 2 layers after identification of the ureteral orifices. Bladder prolapse through a patent urachus can be predicted by prenatal ultrasound and has a distinct neonatal appearance. D

A case of laparoscopic excision of patent urachus

International Surgery Journal

Patent urachus is an uncommon congenital anomaly caused by persistence of embryologic communication between bladder and umbilicus. The traditional surgical approach has been open for years but laparoscopic approach has become an effective and minimal invasive technique to treat urachal remnants. A 11 years old child presenting as umbilical discharge was diagnosed with patent urachus and treated by laparoscopic excision. There was no intra or postoperative complications. Patient was discharged on post-operative day 1. The urachus connects the fetal allantois at umbilicus to the dome of bladder. Normally it obliterates and gives rise to median umbilical ligament. Urachus is extraperitoneal and easily viewed during laparoscopic visualization of pelvis. Urachal remnants represent a rare congenital anomaly due to failure in obliteration process. Complete excision is indicated both in case of persistent symptomatic remnants and also when asymptomatic for the associated risk of malignant d...

Structural and Ontogenetic Study of the Urachus in Human Fetuses

Cells Tissues Organs, 2010

The objective of this work was to conduct an ontogenetic and structural study of the urachus. We studied 40 human fetuses (13–20 weeks post conception, WPC). The urachus was stained in Masson’s trichrome, to quantify connective tissue and smooth muscle and to determine the urachal lumen area. Weigert’s resorcin-fuchsin was used to observe elastic fibers, and picrosirius red and immunohistochemistry analysis were used to observe collagen. The images were captured with Olympus BX51 microscopy and an Olympus DP70 camera. The stereological analysis was done using the software Image Pro and Image J, to determine volumetric densities. For biochemical analysis, the collagen concentrations were expressed per milligram of dry tissue. Means were compared using the unpaired t test (p < 0.05). Quantitative analysis documented a statistically insignificant increase (p = 0.1475) in volumetric densities of smooth muscle in the urachus of males (23.02%), when compared with females (18.43%), and ...

“COMMON URETERIC BUD ANOMALIES” EMBRYOLOGICAL BASIS AND ITS CLINICAL IMPORTANCE

A ureteric bud anomalies occurrence in the world’s population is very common. One in every thousands babies born usually have some form of ureteric bud congenital anomaly. However these congenital anomalies can vary from individual to individual due to science stating that during embryological development, the ureteric bud is responsible for the collecting system, which includes the major and minor calyces of the kidney, the ureter and the bladder. Congenital anomalies can vary to the abnormal development in any of these stated parts.

Prenatally diagnosed patent urachus with bladder prolapse

Journal of Pediatric Surgery, 2007

We report 2 cases of patent urachus with bladder prolapse, which has a characteristic finding of "disappearance of cyst" antenatally. In the first case, a 34-year-old woman presented at 14 weeks gestation for evaluation of a cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared, and a solid mass bulged out inferior to the umbilical cord. At term, the patient delivered a male infant. Examination of the neonate demonstrated mucosal protrusion inferior to the umbilical cord. Catheterization confirmed communication with the bladder. We diagnosed patent urachus with bladder prolapse. In the second case, a 36-year-old woman presented at 19 weeks gestation for evaluation of moderate bilateral hydronephrosis and an abdominal cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared. At term, the patient delivered a male infant displaying patent urachus with bladder prolapse. Understanding of the development of urachus is important for prenatal diagnosis, which in turn allows surgery immediately after birth. We showed bladder function after surgery remains good at school age.

Urorectal septum malformation sequence: Prenatal progression, clinical report, and embryology review

American Journal of Medical Genetics Part A, 2007

The urorectal septum malformation sequence (URSMS) is characterized by severe abnormalities of the urorectal septum (URS) and urogenital organs. The primary defect in this condition appears to be a deficiency in caudal mesoderm leading to the malformation of the URS and other structures in the pelvic region. Recent clinical reports discuss prental findings of URSMS [Lubusky et al. (2006); Prenatal Diagnosis 26: 345-349]. However, here we present a case of URSMS with prenatal findings not previously described, review the literature on URSMS, and summarize current embryological understanding of the pathology seen in hindgut development. The unique prenatal finding in the patient was an abdominally located cystic mass that was first seen at 18 weeks of gestation. Over the next 6 weeks, the mass decreased in size until it disappeared. Concurrent with reduction of the cyst, ascites developed. The patient displayed several traditional URSMS indicators including abnormal bladder and dysplastic kidneys. Our findings give additional insight into the embryology of urorectogenital development. Specifically, they suggest that the cystic mass may have been a persistent urachus prior to septation of the cloaca. Postnatal evaluation confirmed a URSMS diagnosis; the newborn had ambiguous genitalia, hypoplastic kidneys, absent uterus, imperforate anus, smooth perineum, and overall underdeveloped urogenital structures.

Patent Urachus with Bladder Prolapse

Journal of Nepal Paediatric Society, 2014

We report a case of bladder prolapse through a patent urachus in a term male neonate with a large, red, tubular, mucosa lined mass inferior to the umbilical cord. A cystic mass communicating with fetal urinary bladder was detected in an antenatal ultrasound in a 26 years primigravida at 18 and 26 weeks gestation. The cyst disappeared at 35 weeks and a new solid mass was noted at the fetal abdominal wall. After birth a protruded mucosal mass inferior to the umbilical cord was noted. Urethral catherisation confirmed communication with bladder. On the second day of life excision of urachus, repair, reduction of bladder and reconstruction of abdominal wall was performed. The patient voided well and was discharged on ninth day without any complication. DOI: http://dx.doi.org/10.3126/jnps.v34i1.7877 J Nepal Paediatr Soc 2014;34(1):68-70