Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution.
OBJECTIVES
To determine the ideal management of uncomplicated adult urachal remnants and to confirm if conservative management with repeated imaging is acceptable.


PATIENTS AND METHODS
This is a retrospective review of clinical notes and imaging of 45 patients with a mean age of 54.6 years who had been diagnosed with urachal anomalies at a single urology tertiary centre from January 2005 to December 2016. Patients who underwent surgical intervention and findings from patients managed non-operatively, with a mean follow up of 31 months, were evaluated.


RESULTS
Thirty (66.7%) patients had incidental findings, while 15 (33.3%) were symptomatic. Eight underwent excision, one underwent an incision and drainage of abscess, while 34 of the 36 remaining patients elected to undergo surveillance with repeated ultrasound imaging. Two were lost to follow-up. Malignancy was confirmed in three patients. There was interval stability of the urachal remnant in all the patients in the non-operative cohort. The small sample size, limited follow-up, and retrospective nature of the study are recognised limitations.


CONCLUSIONS
It was found that simple and asymptomatic lesions can be monitored with ultrasound, but effort must be made on initial diagnosis to ensure that malignancy is excluded using CT imaging and flexible cystoscopy where possible. Long-term follow-up of this cohort is required to assess the natural history of observed urachal anomalies.
['Hassanbhai|Daanesh H|DH|', 'Ng|Foo Cheong|FC|', 'Koh|Li-Tsa|LT|']
D000038:Abscess D000230:Adenocarcinoma D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D058070:Asymptomatic Diseases D003558:Cystoscopy D005260:Female D006417:Hematuria D006801:Humans D033162:Incidental Findings D059411:Lower Urinary Tract Symptoms D008297:Male D008875:Middle Aged D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D014463:Ultrasonography D014496:Urachal Cyst D014497:Urachus D001749:Urinary Bladder Neoplasms D014552:Urinary Tract Infections D014564:Urogenital Abnormalities D013520:Urologic Surgical Procedures D055815:Young Adult
urachal remnant Urachal anomaly urachal cancer