Conservative management of urachal anomalies
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Mar 2019 · 1 min read
In brief
In brief
Retrospective study comparing urachal anomaly management approaches shows successful shift toward conservative treatment with elimination of routine VCUGs and standardized antibiotic prophylaxis. Nonoperative management in minimally symptomatic patients, particularly those under six months, demonstrated lower complication rates without adverse outcomes or delayed presentations of abscess or sepsis.
Written by the GCMD Library team from the article.
Purpose
The purpose of this study was to evaluate trends in management of urachal anomalies at our institution and the safety of nonoperative care.
Methods
Based on our experience managing urachal remnants from 2000 to 2010 (reported in 2012), we adopted a more conservative approach, including preoperative antibiotic use, refraining from using voiding cystourethrograms (VCUG), postponing surgery until at least six months of age, and considering nonoperative management. A retrospective analysis of urachal anomaly cases was conducted (2011–2016) to assess trends in practice. Charts indicating anomalies of the urachus were pulled and trends in management (nonoperative versus surgical treatment), VCUG and antibiotic use, and outcomes were reviewed.
Results
Data from 2000–2010 and 2013–2016 were compared. Our findings indicate care has shifted towards nonoperative management. A smaller proportion of patients from 2013–2016 was treated surgically compared to 2000–2010. Patients receiving nonoperative treatment exhibited lower rates of complication relative to surgically managed cases. VCUGs were eliminated as a diagnostic tool for evaluating urachal anomalies. Prophylactic preoperative antibiotic use was standardized. No patients with a known urachal remnant presented later with an abscess or sepsis.
Conclusions
We find that a shift towards nonoperative treatment of urachal anomalies did not adversely affect overall outcomes. We recommend observing minimally symptomatic patients, especially those under six months old.
Study type
Performance improvement.
Level of evidence
Level IV.