title: Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram.
abstract: OBJECTIVE
  Children with a wet, draining, or infected umbilicus are often referred to pediatric surgeons. Unfortunately, uniform guidelines regarding diagnostic imaging are lacking. Historically, the persistence of the urachus was attributed to intrauterine distal urinary obstruction. Today, many surgeons continue to advocate preoperative voiding cystourethrogram (VCUG).
  
  
  METHODS
  Records of children with urachal abnormalities over the past 10 years were reviewed. Demographics, presentation, imaging, genitourinary anomalies, operations, length of stay, and complications were recorded. Statistical evaluation was by descriptive analysis.
  
  
  RESULTS
  Fifty-six children were diagnosed with urachal anomalies. Age at operation was 2.5 years (1 day-13 years). Fifty percent of patients were less than 1 year. Ultrasound was used in 88% of cases. Voiding cystourethrogram (34%) and computed tomography (14%) were also used. Average hospitalization was 1.9 (0-13) days. Thirty-two percent underwent operations as outpatients. Seven percent developed wound infections. Eight children (14%) had genitourinary anomalies. However, no VCUG examination (n = 19) documented an obstructive process.
  
  
  CONCLUSIONS
  The current study represents the largest reported series of symptomatic urachal anomalies in children. Disorders of the urachus are variable in presentation with the diagnosis reliably made by history and ultrasound alone. Further testing, including VCUG, is not warranted, adding additional cost, an invasive procedure, and inconvenience to the child.
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
authors.forename: Danny C
authors.initials: DC
authors.lastname: Little
authors.forename: Sohail R
authors.initials: SR
authors.lastname: Shah
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: John P
authors.initials: JP
authors.lastname: Murphy
authors.forename: John M
authors.initials: JM
authors.lastname: Gatti
authors.forename: George K
authors.initials: GK
authors.lastname: Gittes
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Sharp
authors.forename: Walter S
authors.initials: WS
authors.lastname: Andrews
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D002648:Child; D000013:Congenital Abnormalities / Q000175:diagnosis; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014497:Urachus / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014521:Urethra / Q000502:physiology*; D001743:Urinary Bladder / Q000502:physiology*; D014554:Urination