Urethral cyst surgery in children: When should it be performed?

This is an automatically translated article.

The article is expertly consulted by Master, Doctor Le Phuc Lien - Urologist - Department of General Surgery - Vinmec Nha Trang International General Hospital.

1. Pathology existing in the urachal tube in the newborn

The urachal canal originates from the urogenital sinus, a midline tubular structure extending upward from the anterior dome of the bladder to the umbilicus, formed during fetal life. The urachal canal is usually closed and fibrotic into the umbilical-bladder ligament before birth. If there is no postpartum regression, the existence of the urachal tube will cause a number of diseases such as:

Open urachus (patent urachus, some documents are also known as “umbilical-bladder fistula): accounts for about 50% of cases where the urachal canal is present. The disease occurs when there is complete or partial existence of the urachal canal, creating a communication between the umbilicus and the bladder. Children have urine coming out of the navel, when using their hands to gently press on the lower abdomen, the child cries or coughs, the urine comes out more. When methylene blue solution is injected into the bladder, the fluid in the navel will be blue. Conversely, if methylene blue solution is injected into the umbilical fistula, the baby's urine will be blue. Examination of the umbilical cord fluid revealed the nature of the fluid to be urine. Urinary cyst (urachal cyst): Occurs because the urachal tube is blocked at both ends, fluid is stagnate in the middle and forms a cyst. Urinary tract cysts account for 30% of cases where the urachal tract is present. Cysts often have no obvious function, when palpating the abdomen can reveal a cystic, tender, tender, located just below the navel. However, routine examination cannot distinguish an urachal cyst from a subumbilical bowel cyst. Umbilical-urachal sinus: The urachal canal exists partially toward the abdominal wall, communicating with the umbilicus. The urachal sinus accounts for 15% of the urachal pathology cases. vesica urachal diverticulum, 5%: occurs when the urachal tube is blocked below the umbilicus but remains open to the bladder side. Children with the disease often have no clinical symptoms, a small number of children may have an infection due to stagnation of urine. In the past, when imaging techniques were not yet developed, vesicoureteral diverticulum was rarely detected. Recommended video:

Instructions for cleaning the umbilical cord for babies

2. Urethral cyst surgery in infants: when should it be performed?

Of the urachal tract disorders in infants, only open urachal tract disease (umbilical-bladder fistula) has umbilical urine discharge and is detected in the neonatal period. The remaining diseases have unclear clinical symptoms, diagnosis must rely on imaging techniques. Asymptomatic diseases are often detected in adulthood, when these diseases have infection spreading along the midline around the lower abdomen, pelvic infection, ... causing abdominal pain symptoms. below umbilicus, high fever, chills,... The patient will be confirmed after performing imaging techniques such as ultrasound, CT,...

Diseases that exist in the umbilical cord in children, if not treated early, will cause many health risks. Children are susceptible to bacterial infections, the route of infection can be blood, lymphatic or bladder. If left untreated for a long time, the lesions are at risk of degenerating into melanoma in adulthood. In addition to infants diagnosed with open urachal disease at birth. For other children, if they often have abnormal symptoms in the umbilicus and below the umbilicus, parents should take the child to a medical facility with adequate technical facilities for a thorough examination and perform paraclinical techniques to diagnose the condition. timely diagnosis and treatment.
Neonatal urachal cysts and other pathologies due to the existence of the umbilical cord after being confirmed require early surgery. Early treatment when children are young is often simple, highly effective, and limits the risk of infection. However, umbilical cord disease is not a disease requiring emergency surgery, therefore, when the newborn baby is too small, too weak or has another acute illness, surgery may be delayed. they eat. Delayed surgery for a short period of time will not affect the child's health much. In open urachal disease, the umbilical cord often leaks urine, parents must regularly wipe the umbilical cord for the child to avoid infection.
Urethral cyst surgery in children is performed as follows:
Before surgery, the child should be treated with antibiotics if there is an infection of the umbilicus. Surgery is performed under anesthesia. The doctor made a skin incision below the umbilicus, dissected the skin and tissues to expose the urachal-umbilical canal, cut out the lesions of the urachal canal, and sutured the bladder fundus. Stop bleeding, close the incision, bandage the incision. The hospital stay is usually 1-3 days. During the hospital stay, the child will be closely monitored for early detection and timely treatment of complications such as bleeding, wound infection, intestinal obstruction after surgery,...
Resident doctor Le Phuc Lien has more than 12 years of experience in the field of urology and specialized urology, successfully performing many high-tech techniques such as urology endoscopy, urology, urodynamics, neurogenic bladder. Currently, he is a Urologist at the Department of General Surgery, Vinmec Nha Trang International General Hospital.
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SEE ALSO:
Slow umbilical cord cutting beneficial or harmful to the baby? Fetal failure due to knotted umbilical cord - What should the mother do to save the fetus? What is the slow umbilical cord clamp for?