Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study.
Laparoscopic-assisted trans-umbilical approach
Pediatrics
Trans-umbilical approach
Urachal remnant
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
19 Dec 2022
19 Dec 2022
Historique:
received:
09
06
2022
accepted:
28
11
2022
entrez:
19
12
2022
pubmed:
20
12
2022
medline:
22
12
2022
Statut:
epublish
Résumé
The urachus is an embryonic structure that connects the bladder to the allantois during early embryonic development. Occasionally, it fails to disappear at birth, leading to a case of urachal remnant (UR). This study aimed to determine whether our policy for selecting an appropriate UR resection approach is valid. We performed preoperative imaging to examine whether UR continued toward the bladder apex. If so, the UR and bladder apex were excised using the trans-umbilical approach, in addition to laparoscopy, if necessary. If preoperative imaging indicated that the UR ended near the umbilicus, the UR from the umbilicus to the duct end was resected. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging. We retrospectively reviewed pediatric patients with UR who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated. Twenty patients with UR were included (median age, 7 [interquartile range, 2-10.25] years). UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin. Our policy results in complete resection without excessive surgical invasion.
Sections du résumé
BACKGROUND
BACKGROUND
The urachus is an embryonic structure that connects the bladder to the allantois during early embryonic development. Occasionally, it fails to disappear at birth, leading to a case of urachal remnant (UR). This study aimed to determine whether our policy for selecting an appropriate UR resection approach is valid. We performed preoperative imaging to examine whether UR continued toward the bladder apex. If so, the UR and bladder apex were excised using the trans-umbilical approach, in addition to laparoscopy, if necessary. If preoperative imaging indicated that the UR ended near the umbilicus, the UR from the umbilicus to the duct end was resected. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging.
METHODS
METHODS
We retrospectively reviewed pediatric patients with UR who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated.
RESULTS
RESULTS
Twenty patients with UR were included (median age, 7 [interquartile range, 2-10.25] years). UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin.
CONCLUSION
CONCLUSIONS
Our policy results in complete resection without excessive surgical invasion.
Identifiants
pubmed: 36536334
doi: 10.1186/s12894-022-01153-x
pii: 10.1186/s12894-022-01153-x
pmc: PMC9764728
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
207Informations de copyright
© 2022. The Author(s).
Références
J Laparoendosc Adv Surg Tech A. 2019 Aug;29(8):1067-1072
pubmed: 31313966
J Urol. 2015 Feb;193(2):632-6
pubmed: 25219697
J Urol. 2013 Apr;189(4):1260-2
pubmed: 23089466
Children (Basel). 2022 Jan 05;9(1):
pubmed: 35053696
J Urol. 1982 Jan;127(1):40-2
pubmed: 7057501
Medicine (Baltimore). 2018 Jun;97(26):e11043
pubmed: 29952943
Medicine (Baltimore). 2019 Oct;98(40):e17480
pubmed: 31577782
Radiographics. 2001 Mar-Apr;21(2):451-61
pubmed: 11259707
J Anat. 1930 Jan;64(Pt 2):170-83
pubmed: 17104266
Radiographics. 2016 Nov-Dec;36(7):2049-2063
pubmed: 27831842
J Pediatr Surg. 2010 May;45(5):1016-9
pubmed: 20438945
Urol Oncol. 2017 Jan;35(1):33.e11-33.e19
pubmed: 27592530
Pediatr Surg Int. 2015 Jun;31(6):581-7
pubmed: 25896294
Abdom Radiol (NY). 2019 Dec;44(12):3978-3989
pubmed: 31478084