Management of urinary complication in Crohn's disease

PURPOSE: Although urinary complications of Crohn's disease are relatively rare, they often present diagnostic and therapeutic dilemmas. However, there is no established strategy for treating urinary complications of Crohn's disease. In the present clinical study, we describe the frequency of urinary complications of Crohn's disease, and discuss various approaches to their diagnosis and treatment. PATIENTS AND METHODS: The subjects were 1,551 patients who underwent medical treatment for Crohn's disease between January 1994 and May 2002 at Social Insurance Central General Hospital. The subjects were retrospectively evaluated. RESULTS: Urinary complications occuered in 75 of the 1,551 patients (4.8%): urolitiasis in 60 patients, urinary fistula in 14 patients, and urachal abscess (Enterourachocutaneous fitulas) in 1 patient. A total of 41 of the 75 patients with urinary complications (55%) consulted a practicing urologist: 26 patients with urolithiasis, 14 patients with urinary fistula and 1 patient with urachal abscess. 26 patients with urolithiasis received medical treatment: 20 patients underwent conservative therapy, 4 patients underwent ESWL, and 2 patients underwent TUL. In all 26 of those cases, the treatment was successful. Twelve of the 14 patients with urinary fistulas (86%) underwent resection of the inflamed intestine combined with reconstruction of the urinary tract. The 1 patient with urachal abscess underwent resection of the urachus and the inflamed intestine, and partial cystectomy. CONCLUSION: All patients with urolithiasis should be treated the same way, whether or not they have Crohn's disease. In patients with Crohn's disease complicated by urinary fistula, surgery should be performed after preoperative medical therapy, as it improves the quality of life of such patients more rapidly than other approaches and may help avoid intestinal resection.     

Urachal carcinoma: contemporary surgical outcomes

PURPOSE: We determined surgical outcomes in a contemporary series of patients who underwent surgery for urachal carcinoma. MATERIALS AND METHODS: A cohort of 50 patients with clinically staged localized urachal carcinoma underwent extended partial cystectomy, including the urachal tumor mass and entire urachus. The patients were followed a median of 5+ years for cancer-free survival. RESULTS: Of the 50 patients 93% (26 of 28) with tumor confined to the urachus and bladder survived compared to 69% (9 of 13) with extravesical or peri-urachal tumor invasion and none (9 patients) with tumor invasion into the peritoneal cavity. Local recurrence was noted in 9 patients (18%) and 2 had salvage therapy. The most significant predictors of survival were pathological tumor stage and negative surgical margins. CONCLUSIONS: Wide resection of the tumor mass and entire urachus resulting in negative soft tissue and bladder margins cures the majority of nonmetastatic urachal cancers.     

Transitional cell carcinoma of urachus: a case report

We report a case of transitional cell carcinoma of urachus in a 72-year-old man. At follow up cystoscopy for past history of bladder cancer, we found a papillary tumor in the right orifice that came out to the bladder cavity intermittently. Although there was no cancerous lesion on the surface of the bladder mucosa, a submucosal eminence at the dome of bladder was observed. Sagittal magnetic resonance imaging (MRI) revealed an extravesical tumor (2 cm) at the position of urachus. Under the diagnosis of right ureteral cancer and urachal cancer, we performed right distal ureterectomy, ureteral reimplantation and total resection of urachus. Pathological examination revealed transitional cell carcinoma in the urachus and right ureter. The urachal cavity was isolated completely from the bladder cavity. Tumor infiltrated to the muscularis of the bladder dome from the urachal cavity, but there was no cancerous lesion on the surface of the bladder mucosa. Therefore, our diagnosis was urachal transitional cell carcinoma and right ureteral carcinoma.     

Squamous cell carcinoma of the urachus producing granulocyte colony-stimulating factor

Urachal carcinoma is a rare cancer. This is the first report of a case of squamous cell carcinoma of the urachus producing granulocyte colony-stimulating factor. The patient underwent partial cystectomy with urachal remnant resection and pelvic lymphadenectomy. No evidence of tumor recurrence or metastasis was found at 17 months after surgery.     

Laparoscopic partial cystectomy with en bloc resection of the urachus for urachal adenocarcinoma

Abstract:   Urachal carcinoma accounts for less than 1% of bladder cancers. The preferred treatment is wide local excision with partial or radical cystectomy. Two patients who presented with urachal carcinoma underwent laparoscopic partial cystectomy with en bloc resection of the urachus and bilateral pelvic lymphadenectomy as a less morbid, minimally invasive surgical alternative. Laparoscopic excision was successfully carried out in two cases with an uneventful convalescence.     

Clinical investigation of 9 cases of urachal carcinoma]

Recently, we encountered 9 cases of urachal tumor and conducted clinical studies on its diagnosis and treatment. The chief complaint was gross hematuria in all cases. Computed tomographic scan was performed in 7 cases, and in all cases it revealed a tumor between the dome of the bladder and the Retzius' cavity. This finding strongly suggested a urachal tumor before pathological study. Magnetic imaging resonance (MIR) was performed in one of the 9 cases, and it indicated the extent of the tumor more clearly than computed tomography. Partial cystectomy + en bloc removal of the umbilicus and urachus was performed in 5 cases, radical cystectomy + en bloc removal of the umbilicus and urachus was performed in 2 cases, and radical cystectomy was performed in 2 cases. As postoperative therapy, radiotherapy was administered to 4 cases, and chemotherapy was administered to 4 cases. One case died from cancer after 4 years and 10 months, while the other 8 cases are being treated on an outpatient basis without any local recurrence. All 5 patients who underwent partial cystectomy are alive (mean survival time: 97 months). Thus we believe that cure can be achieved by partial cystectomy and adjuvant therapy. In addition, serum carcinoembryonic antigen is thought to be useful as an indicator of residual tumor or local recurrence.     

Urachal anomalies: ultrasonography and management

Background: Fifty-six children with anomalies of the urachus remnant identified by ultrasound scan have been encountered in the authors’ hospital over the last 4 years.Methods Twenty of these 56 cases were symptomatic urachal remnants, whereas the urachus remnants were seen incidentally by ultrasound scanning in the other 36 patients. Symptomatic cases were treated with antibiotics or observation. Then, symptomatic cases were divided into 2 groups. One group, surgical group, was treated with surgical resection of the urachal remnant. The other group, observation group, was followed up without its surgical resection. Forty-four patients, 11 cases of symptomatic urachal remnant and 33 asymptomatic cases, were followed up, excluding patients who had surgical treatment and who were lost to follow-up.Results Thirty patients underwent periodical ultrasonographic examination during follow-up. In 9 cases, including 2 symptomatic cases, urachal remnants have disappeared during the follow-up period spontaneously. No symptom had developed during follow-up from asymptomatic cases.Conclusions The patients with asymptomatic urachal remnants do not require follow-up, and urachal remnants, especially those under 1 year of age, do not require surgical resection unless the patient has multiple episodes.     

Carcinoma of urachus: report of 15 cases and review of literature--is total cystectomy the treatment of choice for urachal carcinoma?

PURPOSE: This study was undertaken to determine the most appropriate type of operation for the improvement of the radical cure rate and QOL of patients with urachal cancer. We assessed the association between the stage, type of operation, and prognosis of cases we experienced and those reported in Japan. PATIENTS AND METHOD: The subjects included 15 cases of urachal cancer we have experienced in the past 14 years. While clarifying the clinical patterns of these cases, the association between stage, type of operation, and prognosis was studied. Of the cases of urachal cancer reported in Japan in the recent 20 years, 75 cases in which the stage, type of operation, and prognosis were documented were selected, and the association between the stage and outcome in each type of operation was studied. RESULTS: In regard to stage, all the cases were rated as more than IIIA. As for prognosis, 9 cases (60%) are alive without cancer at the present time with a mean survival time of 7 years. Of the above patients, 3 underwent cystectomy and 6 underwent en bloc segmental resection (herein after referred to en bloc). Recurrence or cancer death was experienced in 5 patients, 2 of which were classified as stage IIIA and 3 as IIID. Of these patients, one underwent en bloc, 3 partial resection of the bladder, and one underwent exploratory laparotomy. As far as our study of the cases reported in Japan is concerned, the prognosis of the cases having undergone only partial resection of the bladder was poor, while of the cases having undergone en bloc or total cystectomy 88-100% were alive without cancer for more than 2 years if their stage was classified as IIIA or below. On the other hand, prognosis was very poor whatever the type of operation in the cases whose cancer was stage IIIC or above. CONCLUSIONS: It appears that the en bloc is most appropriate as the type of operation for the cases of urachal cancer and that the application of total cystectomy is limited to some cases. In performing the en bloc, an extensive resection of the peritoneum, resection of the posterior sheath of the rectus muscle of the abdomen, and dissection of the intrapelvic lymph nodes in addition to the conventional types of operation should be carried out positively.     

腹腔镜手术切除六例小儿脐尿管囊肿的临床报告

目的探讨腹腔镜治疗小儿脐尿管囊肿的时机、方法和效果。 方法回顾性分析自2014年10月至2017年10月在中山大学附属第一医院和深圳市儿童医院小儿外科收治的6例经腹腔镜治疗的小儿脐尿管囊肿临床资料。女2例,男4例,平均年龄5岁1个月。术前均经超声和CT确定诊断,脐尿管囊肿大小为1.1～3.0 cm,4例位置近膀胱,2例在脐尿管的中间位。3例无症状的择期手术,3例有症状的在感染控制后择期手术,全部6例均采用脐部和平脐两侧腹壁进三个曲卡的方法,进行了腹腔镜脐尿管囊肿切除术。 结果本组患儿手术全部顺利完成,术中囊肿均完整无破溃,手术时间45～80 min,平均60 min。术中和术后无并发症。病理均符合诊断。随访6～43个月,6例患儿均恢复顺利,腹部切口瘢痕不明显,患儿家属满意。 结论小儿脐尿管囊肿腹腔镜下可完整切除,手术安全、有效、恢复快速,外观良好。     

Laparoscopic management of urachal cysts in adulthood

PURPOSE: Managing persistent and symptomatic urachal anomalies requires wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. However, traditional open excision is associated with significant morbidity and prolonged convalescence. We report our experience with the laparoscopic excision of urachal remnants as a less morbid, minimally invasive surgical alternative. MATERIALS AND METHODS: Between October 1993 and December 1999, 4 patients with a mean age of 43.3 years who had a symptomatic urachal cyst underwent laparoscopic radical excision of the urachal remnant. Using 2, 10 mm. and 1 or 2, 5 mm. ports the urachus and medial umbilical ligaments were divided at the umbilicus cephalad to the cyst. The specimen, which included the urachus, cyst and medial umbilical ligaments, was then separated from the bladder dome with or without the bladder cuff and removed intact. We reviewed the perioperative records to assess morbidity, recovery and outcome. RESULTS: All 4 procedures were completed successfully. No intraoperative or postoperative complications were reported at a mean followup of 15 months (range 2 to 24). Mean operative time was 180 minutes (range 150 to 210) and average hospital stay was 2.75 days (range 1 to 4). Pathological evaluation confirmed a benign urachal remnant in each case. All patients resumed normal activity within 2 weeks. CONCLUSIONS: To minimize the morbidity of radical excision the laparoscopic management of benign urachal remnants in adulthood is efficacious and our preferred method of management.     

Adenocarcinoma of the urinary bladder

We report 40 patients seen over a 15-year period with a histological diagnosis of adenocarcinoma of the bladder; 18 patients had primary adenocarcinoma of the bladder, arising either from the urachus or from glandular metaplasia of the urothelium, and the other 22 had secondary lesions representing invasion from adjacent structures, notably prostate, colon and ovary. In this latter group symptoms related to the primary lesion were variable. The distinction between primary and secondary neoplasm is an important one and was rarely made on the basis of endoscopic or clinical findings alone. Urachal tumours were more common in females, whereas primary and secondary vesical adenocarcinomas were more common in males. The urachal tumours also occurred in a younger age group. Most of the adenocarcinomas, urachal or primary, were already advanced at the time of diagnosis. All tumours were palpable bimanually after resection and were at least T2 or T3. In the urachal carcinomas the results of partial cystectomy were disappointing because of the high rate of local recurrence and death from metastases. Primary non-urachal vesical adenocarcinoma carried an even poorer prognosis if non-radical surgery was carried out. The mean survival was 13 months. Radiotherapy was not effective in urachal and primary adenocarcinomas as these tumours are generally radioresistant. The treatment of secondary adenocarcinoma was governed by the primary site of the tumour. Radical surgery combined with chemotherapy and radiotherapy appeared to give the longest survival in the colonic tumours. Patients with prostatic cancer had a poorer survival rate than those with the same stage tumour but without bladder involvement, with renal failure secondary to obstructive uropathy being the commonest cause of death.     

CONGENITAL PATENT URACHUS IN AN ADULT: A CASE REPORT

A rare case of the congenital patent urachus in an adult is reported. The patient, a 42-year-old man, was admitted with the chief complaint of macroscopic hematuria. During the cystoscopy perfusion water discharged from the umbilicus. Diagnostic imaging revealed a tubular fistula between the bladder and umbilicus and the patient underwent -urachal resection and partial cystectomy. Microscopically the lumen was lined by transitional, columnar and squamous epithelium and there was no evidence of malignancy. To date 11 cases of congenital patent urachus in an adult have been reported in Japan. From a review of the Japanese literature, the common chief complaint is urine discharge from the umbilicus accompanying cystitis and/or urachal inflammation. Urachal resection is performed in all cases. We also clarified the epithelial histology of the patent urachus in this patient.     

Abscess of urachal remnant mimicking urinary bladder neoplasm.

Three cases of urachal abscess with extensive interstitial inflammation and fibrosis are reported. Clinically, all patients had a lower abdominal mass and CT scan and ultrasonic examination revealed a large tumour located anterior or superior to the bladder. They all underwent laparotomy and had either a partial cystectomy or an en bloc resection of the bladder and adjacent organs due to severe adhesions. Microscopic examination of the specimens revealed no evidence of carcinoma and only abscess formation with extensive chronic interstitial inflammation and fibrosis were seen. In one case, residual columnar epithelium suggestive of urachal origin was identified in the abscess cavity. Urachal abscess should be considered when dealing with lower abdominal masses.     

膀胱腺癌的诊断和治疗(附29例报告)

目的提高膀胱腺癌的诊断与治疗水平。方法29例中原发性膀胱腺癌18例，其中行全膀胱切除、尿流改道11例，膀胱部分切除7例；脐尿管腺癌9例，6例行扩大膀胱部分切除术，3例行全膀胱切除、尿流改道；印戒细胞癌2例，行全膀胱切除、尿流改道术。结果4例患者失访，25例患者随访时间为5个月一10年。生存1年者17例（64％），生存2年15例（60％），生存5年5例（20％），生存时间超过5年者均为早期患者。结论早期诊断、鉴别原发性膀胱腺癌与脐尿管腺癌、选择合适的手术方式是膀胱腺癌治疗的关键。     

腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤五例报告并文献复习

目的探讨腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤的可行性和临床疗效。 方法回顾性分析我院采用普通腹腔镜和达芬奇机器人辅助腹腔镜下扩大膀胱部分切除术治疗脐尿管肿瘤5例临床资料,手术切除范围包括脐尿管、脐孔、脐尿管肿物、脐正中韧带、部分腹膜以及与脐尿管肿物相连的部分膀胱顶部,对手术时间、术后住院天数、有无术后并发症及随访有无肿瘤复发等指标进行分析,评价手术疗效。检索国内外相关文献,讨论脐尿管肿瘤的发病特点、影像学特征以及治疗方法。 结果5例手术均成功,无中转开放,平均手术时间140 min,术中出血少,术中术后无严重并发症出现,术后平均住院天数7.4 d,其中3例行术后辅助化疗3个疗程,化疗方案为顺铂+紫杉醇,术后随访1~4年无复发。术后病理诊断1例为绒毛状腺瘤,3例为脐尿管黏液腺癌,1例为浸润性高级尿路上皮癌,所有病例切缘及淋巴结均未见癌累及。 结论腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤,是一种安全、有效的方法。     

La pathologie malformative de l’ouraque: A propos de 12 cas colligés au service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar,Sénégal

Objectivesto report the epidemiological aspects, diagnosis and treatment of urachal anomalies.Patients and methodsWe conducted a retrospective study in Pediatric Surgery department of Hospital Aristide Le Dantec for a period of 15 years. The parameters studied were the prevalence, sex, age, reason for consultation, clinical, paraclinical, treatment, hospital stay and evolution of urachal anomalies.ResultsWe collected 12 cases of malformative diseases of the urachus, for a prevalence of 0.8 cases/year. Our sample consisted of seven boys and five girls with a sex-ratio of 1.4. The mean age was 1.6 years. We noted a predominance of fistulas of the urachus with 8 cases. Drainage of fluid from the umbilicus was the most common sign in 8 cases. Fistulography was requested for two patients and confirmed the diagnosis of fistula of the urachus. In other cases the diagnosis was made intraoperatively. Surgical treatment was performed in 10 patients and consisted of a laparotomy followed by resection of urachal tissue including a collar of the bladder dome. one case was observed for regression of symptoms. After a mean of 6 months the evolution was marked by the occurrence of an evisceration of infectious origin, three cases of wound infection and two deaths.ConclusionsAnomalies of the urachus are rare in our service. The male is most affected. Drainage of fluid from the umbilicus is the most common sign. Ultrasound should be systematic in the preoperative evaluation and treatment should be surgical.     

Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.     

Treatment of bladder carcinoma in patients more than 80 years old

We reviewed 26 patients more than 80 years old with bladder carcinoma to determine if an active surgical policy is justified. Ten patients with superficial carcinoma were treated with transurethral resection; none died of cancer and half have survived 5 years. Of 16 patients with invasive carcinoma 9 underwent total cystectomy with urinary diversion and 2 underwent partial cystectomy. There was no operative mortality. Postoperative complications were not serious. Five of the 9 patients who underwent total cystectomy are alive, with a mean survival of 35 months. The 4-year crude survival rate was 50 per cent. Both patients who underwent partial cystectomy died within 2 years. One patient treated with radiotherapy alone and 1 without any treatment have survived 2 years. These results suggest that contrary to the general tendency towards conservative treatment, a curative operation is worth attempting in elderly patients with bladder carcinoma.     

Clinical investigation of 7 cases of urachal carcinoma

Seven cases of urachal carcinoma experience in Yokohama City University in these 10 years are presented herein. The high incidence of local recurrence of this disease and the results of the treatments in the previously reported cases were reviewed. From these experiences, extensive radical surgery including total cystectomy, en bloc removal of entire urachus, pelvic lymphadenectomy, and adjuvant chemotherapy and or radiation are recommended for the treatment of urachal carcinoma.     

Urachal adenocarcinoma

The authors report a case of mucinous adenocarcinoma of the urachus treated with partial cystectomy. The urachal cancer is an uncommon clinicopathologic entity associated with a poor prognosis. Anatomical considerations, clinical features and treatment are discussed.