Mesrobian H G, Zacharias A, Balcom A H, Cohen R D
Division of Pediatric Urology, Children's Hospital, Milwaukee, Wisconsin, USA.
J Urol. 1997 Sep;158(3 Pt 2):1316-8. doi: 10.1097/00005392-199709000-00173.
The embryological and anatomical features of urachal anomalies have been well defined. Because of the variable clinical presentation, uniform guidelines for evaluation and treatment are lacking. In an attempt to establish a cost-effective approach leading to a favorable outcome, we reviewed the experience with urachal anomalies at a single institution in a 10-year period.
We reviewed the medical records and radiological studies of 12 boys and 9 girls newborn to 17 years old at presentation who were treated for a urachal anomaly. Diagnostic evaluation included voiding cystourethrography in 14 cases, ultrasound in 8, sinography in 7 and computerized tomography in 4.
The 4 variants of urachal anomalies included a urachal sinus in 9 patients (43%), urachal cyst in 9 (43%), patent urachus in 2 (10%) and urachal diverticulum in 1 (4%). Treatment involved initial excision in 13 cases (61%) and secondary excision in 8 (39%). Staphylococcus aureus was the predominant organism recovered.
Because of the variable presentation, the diagnosis of a urachal anomaly can be difficult. Our experience suggests that a cost-effective diagnostic approach can be developed based on the initial clinical evaluation. Whereas ultrasound is indicated when a urachal cyst or abscess is suspected on the initial study, sinography is the study of choice in the remainder of cases. A voiding cystourethrogram may not be required in view of the fact that none of the patients studied had an additional associated urinary tract anomaly.
脐尿管异常的胚胎学和解剖学特征已得到明确界定。由于临床表现多样，目前缺乏统一的评估和治疗指南。为了建立一种能带来良好结果的经济有效的方法，我们回顾了一家机构在10年期间处理脐尿管异常的经验。
我们回顾了12名男孩和9名女孩（年龄从新生儿到17岁）因脐尿管异常接受治疗的病历和放射学研究。诊断评估包括14例排尿性膀胱尿道造影、8例超声检查、7例窦道造影和4例计算机断层扫描。
脐尿管异常的4种类型包括9例脐尿管窦（43%）、9例脐尿管囊肿（43%）、2例脐尿管未闭（10%）和1例脐尿管憩室（4%）。治疗包括13例（61%）的初次切除和8例（39%）的二次切除。金黄色葡萄球菌是最常见的分离出的病原体。
由于表现多样，脐尿管异常的诊断可能困难。我们的经验表明，基于初始临床评估可以制定一种经济有效的诊断方法。如果初始检查怀疑有脐尿管囊肿或脓肿，则应进行超声检查，而在其余病例中，窦道造影是首选检查。鉴于所研究的患者均无其他相关泌尿系统异常，可能不需要进行排尿性膀胱尿道造影。
