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urachus

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brian mcardle

on 19 October 2015

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Transcript of urachus

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29%
48%
Generally benign. . .
Development and
Pathology

The Urachus
Development
Landmarks
bladder
Anomalies
Bleeding
Infection
Neoplasia

Scheldon C., Clayman R., Gonzales R. Malignant urachal lesions, J Urology, 1984

Hatch, David, MD. "Normal Bladder Development" http://www.meddean.luc.edu/lumen/MedEd/urology/nlbladdv.htm

The Clinical Epidemiology of Urachal Carcinoma: Results of a Large, Population Based Study; Bruins HM, Visser O, Ploeg M, Hulsbergen-van de Kaa CA, Kiemeney LA, Witjes JA; Journal of Urology (Aug 2012)

Park JM. Normal development of the urogenital system. In Campbell- Walsh Urology. Wein, Kavossi, Novick, Partin, Peters eds. 2007. Elsevier, Philadelphia.

Ashey RA, Inman BA, Routh JC, et al. Urachal Anomalies: A longitudinal study of urachal remnants in children and adults. J Urol 2007; 178:1615-1618.
CT Pelvis
Don, 50yo M
6wk hx hematuria, pneumaturia
workup
UA: 3+ blood, >5 epithelial RBCs/hpf
Cystoscopy
Biopsy
CEA, CA19-9 elevated
Hg 9.0
Urothelial Carcinoma
PE: Firm, mobile suprapubic mass
Labs
Urachal
Adenocarcinoma
152
1989-2009
of all bladder cancers
30%
patients
presented with
distant metastasis
Netherlands Cancer Registry + Nationwide Network and Registry of Histology and Cytopathology
Often discovered late in disease process
Poor Prognosis
45%
48%
5yr Survival
Overall Survival
Journal of Urology 2012
References
incidence
20%
35%
incidence
incidence
incidence
43%
2%
Drainage
Mass/Infection
Pain
Asymptomatic
Incidental
12%
6%
5%
Toureux's Fold
Rathke's plicae
Urorectal septum
10wks
12wks
Vesico-allantoic canal
Cylindrical bladder
Vesico-allanotic canal
Median umbilical fold
MC 1/3
Methylene
blue
Indigo
carmine
Cr
Urea
Pediatric presentation
Go Irish, Beat Spartans
Sheldon Staging 1994
?
I
I. limited to urachal mucosa
II. Limited to urachus
IIIa. Local to bladder
IIIc. Local to peritoneum
I
II
IIId. Local to organs
IVa. Mets via Lypmh
IVb. Distant Mets
III = Local
IIIb. Local to abd wall
IV = Mets
IV = Mets
IVb
Full transcript