Urachal remnants: an enigma.

Aim: To determine what should be done with incidentally discovered urachal remnants.

Materials And Methods: A 10-year retrospective study revealed 24 patients with urachal remnants. The histology of the urachal remnants was reviewed. A review of the data on urachal carcinoma in adults diagnosed and treated during the same period in an adjacent adult hospital was carried out. A review of the literature was also performed.

Results: In the 23 patients where histology was available 17 had normal urothelial lining and 6 (25%) showed abnormal epithelium. This included colonic epithelium, small intestinal epithelium and squamous epithelium. Four of the patients with abnormal epithelium were in the group of "incidental removals". During the 10-year period, 4 cases of urachal carcinoma were managed at the adult urology centre. Three had extensive disease at presentation. Two died of the disease while the third died of myocardial infarction 5 months after resection. Only one was alive at one-year follow-up. The occurrence of such documented complications makes a strong case for "prophylactic" surgery when urachal remnants are diagnosed incidentally or recognised during other operative procedures. All paediatric patients who underwent excision of urachal remnants had an uncomplicated clinical course.