A urachal diverticulum is an uncommon developmental condition characterized by a small pouch or sac connected to the bladder. This anomaly arises from incomplete closure of a structure present during fetal development. While often asymptomatic, it can sometimes lead to complications.
Understanding the Urachus
During early fetal development, a tubular structure known as the urachus forms, connecting the embryo’s bladder to the umbilicus. Normally, by around the 12th week of gestation, or shortly after birth, the urachus completely closes off, transforming into a fibrous cord called the median umbilical ligament.
A urachal diverticulum occurs when the portion of the urachus closest to the bladder fails to fully close, while the umbilical end successfully obliterates. This incomplete closure results in a blind-ending pouch directly connected to the bladder.
Recognizing the Signs
A urachal diverticulum often does not cause symptoms and may be discovered incidentally during imaging for other reasons. However, symptoms commonly arise if the diverticulum becomes infected. Infections can lead to abdominal pain, fever, or pain during urination.
Diagnostic imaging techniques are used to confirm the presence of the condition. An ultrasound is often the initial test. More detailed imaging, such as CT scans or MRI, may be performed. A voiding cystourethrogram (VCUG), which involves filling the bladder with a contrast dye and taking X-rays, might also be used, especially if recurrent urinary tract infections are a concern.
Managing the Condition
If a urachal diverticulum is left untreated, complications can develop. Recurrent urinary tract infections are common, as the pouch can become a breeding ground for bacteria. Stones can also form within the diverticulum due to urine stagnation. In rare cases, the diverticulum might rupture, requiring immediate medical attention. There is also a very rare risk of malignant transformation, where cancerous cells can develop within the remnant tissue.
The primary treatment for a symptomatic urachal diverticulum, or one posing a risk of complications, is surgical removal. This procedure, known as excision, involves removing the abnormal pouch. Surgery is recommended even for asymptomatic cases to prevent future issues like infections or stone formation. The surgery can be performed using minimally invasive techniques, such as laparoscopy, which allows for a shorter hospital stay. While non-surgical management with antibiotics may address acute infections, surgical excision is the definitive treatment to prevent recurrence and complications.