title: Symptomatic urachal remnants: Case series with results of a robot-assisted laparoscopic approach with primary umbilicoplasty.
abstract: OBJECTIVE
  Between 2012 and 2014, nine consecutive patients with symptomatic urachal remnants were treated at Roskilde Hospital, Denmark, with a robot-assisted laparoscopic en bloc resection of their urachal remnants with partial cystectomy and umbilectomy with primary umbilicoplasty. The objective of this study is to report surgical results and give recommendations for the management of urachal remnants.
  
  
  METHODS
  The patient group consisted of four women and five men with a median age of 59 years. Indications for surgery included bothersome umbilical secretion in two patients, and suspicion of malignancy in seven patients with unexplained haematuria. Three patients also suffered from recurrent urinary tract infections. Urachal remnants were confirmed on computed tomography scans in all patients. The median surgical time was 120 min with no significant intraoperative problems.
  
  
  RESULTS
  The surgical approach led to cosmetically satisfactory results in all patients. However, three patients suffered subsequent rupture of the fascia and one required an exploratory laparotomy to secure haemostasis of a bleeding spleen. Histology revealed a well-differentiated adenocarcinoma with negative surgical margins in one patient while no signs of malignancy were observed in the remaining eight patients. Umbilical secretion, haematuria and urinary infections subsided in all patients after the surgery.
  
  
  CONCLUSIONS
  Based on these findings, it would be reasonable to offer surgery to patients with symptomatic urachal remnants. However, one should be aware that there is a significant risk of complications and that the risk of cancer seems to be limited.
authors: a Department of Urology , Zealand University Hospital , Roskilde , Denmark.
authors: Mikkel
authors: M
authors: Fode
authors: a Department of Urology , Zealand University Hospital , Roskilde , Denmark.
authors: Gyrithe L
authors: GL
authors: Pedersen
authors: a Department of Urology , Zealand University Hospital , Roskilde , Denmark.
authors: Nessn
authors: N
authors: Azawi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D014472:Umbilicus / Q000601:surgery*; D014497:Urachus / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D014571:Urologic Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Adenocarcinoma; haematuria; robotic surgery; urachal remnants; urachus