Canubas Patent Urachus

PATENT URACHUS
Canubas, Laly Rose D.

Medical Definition of Patent Urachus
A surgery to repair a bladder defect. In an
open (patent) urachus, there is an opening
between the bladder and the umbilicus. The
opening usually closes before birth. An open
urachus typically occurs in infants
These conditions result from the failure of
the involution of normal embryologic tissues
that serve to empty the fetal bladder
Medical Definition of Patent Urachus
 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
Some of these urachal anomalies
are obvious at birth, while
others are more subtle and not
diagnosed until adulthood or
only incidentally discovered
after imaging is obtained for
other reasons
Etiology
During the fourth week of embryogenesis, the three-
layered embryonic disk folds into a cylindrical
shape
The umbilical vessels (two umbilical arteries and
one umbilical vein), urachus, and omphalomesenteric
duct enter into the now narrowed interface between
the yolk sac and embryo
The omphalomesenteric duct connects the developing
gut to the yolk sac
Etiology cont’
The omphalomesenteric duct connects the developing
gut to the yolk sac
The allantois forms to become the urachus, which
connects the developing bladder to the umbilicus.
Obliteration of the urachus is believed to occur at
the end of gestation, with some believing that it
occurs in the first few days following birth
After involution, a fibrous cord remains in the
preperitoneal space between the umbilicus and the
bladder.
Etiology cont’
Failure of involution results in a spectrum
of urachal anomalies related to the amount
and location of residual tissue
Total failure results in a patent, tubular
connection between the urinary bladder and
umbilicus. A bladder diverticulum occurs when
there is persistent tissue at the bladder
with no connection to the umbilicus.
Etiology cont’
Persistent tissue at the umbilicus with no
connection to the bladder is called an umbilical
polyp or sinus. A urachal cyst results when there
is patency along the midportion of the urachus with
the closure of the tract at the umbilicus and
bladder.
Epidemiology
The incidence of urachal anomaly is considered
difficult to determine, as some have urachal
anomalies that are asymptomatic or undiagnosed
True patent urachus is believed to be a rare
entity, which was confirmed in a review study
conducted at the Hospital for Sick Children in
Toronto, Canada
The prevalence of all urachal anomalies in their
general pediatric population was 1.03%
Epidemiology cont’
True patent urachus was a rare diagnosis,
representing only 1.5% of all diagnosed urachal
anomalies
The median age of diagnosis varies widely between
studies. In general, true patent urachus is
diagnosed earlier in life, given the obvious
physical exam findings, including near-constant
leakage of urine from the umbilicus
Epidemiology cont’
Urachal anomalies are associated with
posterior urethral valves, as a patent
urachus may be the only relief valve for
an otherwise obstructed urinary tract.
Consequently, the incidence in male
children is three times higher than in
female children
History and Physical
The average umbilical cord is 1.5 cm in diameter
and 3.6 cm in circumference
An abnormally thick cord should prompt further
investigation for the potential for urachal anomaly
If no visible abnormalities are present at birth,
some infants and older children are brought to
their pediatrician with the complaint of persistent
umbilical drainage with classic urinous discharge
Umbilical polyps can manifest as umbilical drainage
with abnormal appearing tissue at the umbilicus
unresponsive to silver nitrate
Other children, particularly those with urachal
cysts, present later in life with infection
resulting in periumbilical cellulitis, abdominal
pain, suprapubic pain, and/or palpable mass
Physical exam should focus on identifying any
umbilical defects, sinus tracts near the umbilicus,
palpable masses posterior to or just distal to the
umbilicus, and examining the umbilicus for movement
with micturition or discharge with gentle pressure
applied to the bladder
Evaluation
In a newborn with visible umbilical cord

abnormality, an ultrasound helps to delineate the
diagnosis further
If ultrasound demonstrates thickened tissue with a
possible connection to the bladder, a repeat
ultrasound should be performed in six to twelve
months
 In the case of an infant with patent urachus, a
voiding cystourethrogram should be performed to
evaluate for other urinary tract abnormalities,
such as posterior urethral valves
In the case of posterior urethral valves, a patent
urachus may represent the only pathway for the flow
of obstructed urine
In the child with the complaint of persistent
umbilical wetness, the physical exam should focus
on identifying any abnormal opening in the
umbilicus or for any palpable masses posterior or
just distal to the umbilicus
 If there is a question if the fluid being
expressed from the umbilicus is urine, it can be
sent for creatinine. If there is an obvious
opening, a sinogram can be performed, which
involves injecting contrast into the tract

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PATENT URACHUS

Canubas, Laly Rose D.

In a newborn with visible umbilical cord

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