Urachal Diseases Fluid and Urine Discharge from the Umbilical cord

What is the urachus?

The urachus is a tube-shaped structure that begins to develop while the baby is in the womb and is open in the first weeks of pregnancy. It is located between the allantois, one of the structures in the umbilical cord, and the upper part of the baby's bladder. This opening normally closes and becomes completely blocked in the 12th week of pregnancy. It then takes the form of a cord extending between the inner part of the navel and the bladder.

Urachus Anomalies: Fluid - Urine Discharge from the Umbilical cord

There is a channel-shaped relationship between the navel and the bladder (urinary bladder) while in the womb. There is (urachus canal). This channel closes in the third month of pregnancy. When there are problems with the closure of this connection, 3 types of diseases occur.

Urachal fistula (Opened urachus):Closing does not occur at all and the connection between the bladder and the navel continues, urine coming from the navel. It manifests itself as: The most appropriate method to detect this is to take a film in the lateral position by administering a special dye through a thin catheter inserted through the opening in the umbilicus where the discharge occurs. If the duct is open, it can be seen that the dye reaches the bladder from here. The treatment method is to remove the duct surgically.

Uracal Sinus: Sometimes the relationship between the duct and the bladder may be closed, but only the umbilicus remains open. The belly is always moist. Sometimes it can be seen together with a small granuloma. The treatment is extraperitoneal removal of the sinus.

Uracal Cyst: In some cases, the secretion formed from the duct wall may lead to the formation of a cystic structure under the navel. In these children, clear fluid may come from the navel or the cystic structure may become infected. It most often manifests itself as a mass between the navel and the symphysis pubis. Ultrasound and cystography are used in diagnosis. Treatment requires surgical removal of the residue. Urachal anomalies can be treated using open or closed methods.

How to Diagnose Urachal Diseases?

Radiological imaging methods vary depending on your child's complaints. Catheter voiding to make the diagnosis in case of patent urachus with clear fluid discharge or urine from the navel Cystogram or medicated x-ray (sinography) is taken by advancing the catheter through the umbilicus.

Although the risk of anomalies in the urinary tract and kidneys is low, ultrasonography should be performed to evaluate them. A urachal cyst on the bladder can be detected in ultrasonography. Infected urachal cysts can reach very large sizes and cause infection in the surrounding tissues and even in the abdomen. In suspicious cases, computed tomography may also be useful for diagnosis.

How is Treatment Done in Urachal Diseases?

The treatment of urachus anomalies that cause symptoms and complaints is surgical excision.

From the navel to the bladder dome. The urachus is completely removed. If it is closely related to the bladder or if there is a bladder diverticulum, it must be removed along with a part of the bladder. It is appropriate to remove urachal remnants and cysts that do not cause any symptoms by surgery, as they potentially cause problems.

If babies under the age of 6 months are detected incidentally and do not have any complaints or symptoms, they are followed up to the age of 1-1.5 years. Urachal openings and cysts that do not close are more likely to occur Surgery should then be performed.

In urachal cyst patients who have started antibiotic treatment due to infection, surgery should be planned to completely remove the umbilical and bladder connection of the urachal cyst after the post-treatment findings improve. In cases where the urachus is not completely removed, there is a risk of infection of the remaining tissues and recurrence of the urachus cyst. In patients operated on during infection, the surgical area is larger, tissue loss is greater, and wound healing is more problematic. Rarely, an infected urachual cyst opens into the intestines and causes damage to the intestines.

In young children, urachual cyst excision can be performed by reaching both the umbilicus and the bladder dome through a small 1.5 cm incision made between the navel and the bladder. In older or overweight children, the incision must be lengthened. The risk of complications after surgery was low. If a part of the bladder dome associated with the urachus cyst is removed, bladder closure is performed and a urinary catheter is placed in the bladder for 5 days. Your child urinates into a bladder that is attached to the bladder catheter. Postoperative wound healing or urine leakage from the bladder There may be problems.

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