Urachal Cancer: Experience of a High-Volume Bladder Cancer Center

Introduction: Primary urachal cancer (UrCa) is rare, with an estimated incidence of 0.2% - 0.5% of all bladder tumors. Although the preferred treatment is surgical, there is no consensus on the best approach. We present our experience managing 14 cases of primary UrCa. Methods: A retrospective analysis was conducted on the clinical records of a high-volume bladder cancer center in the UK to identify patients diagnosed with UrCa between May 2013 and June 2022. Results: 9 males and 6 females, aged between 30 and 85 years, were included. The diagnosis was most commonly made via flexible cystoscopy and CT for haematuria. 3 patients had metastasis at presentation, and while radiologically no patients showed positive lymph nodes, 2 patients were found to have positive lymph nodes on histopathology. 13 patients underwent partial cystectomy, with 1 undergoing radical cystoprostatectomy. 8 patients underwent concurrent umbilectomy and/or lymphadenectomy. The most common histological subtype was mucinous adenocarcinoma. 2 patients experienced local recurrence and underwent transurethral resection, while 6 patients experienced metastasis. Metastasis-free survival rate was 74.1% and 55.6% at 12 and 24 months, respectively. Umbilectomy and lymphadenectomy did not decrease rates of positive surgical margin, local recurrence, metastasis, or mortality. Conclusions: UrCa is a rare and aggressive malignancy that can occur at any age and may be advanced upon presentation. Bladder-sparing surgery is becoming more prevalent, with chemotherapy being reserved for recurrence or metastasis. In our series, routine umbilectomy and lymphadenectomy did not improve oncologic outcomes. However, lymphadenectomy may have a role in cancer staging.

Clinical comparison of patients with benign urachal masses versus urachal carcinomas

The clinical features of 17 patients with benign urachal masses and 30 patients with urachal carcinoma treated at Sun Yat-sen University Cancer Center were analyzed retrospectively. Univariate analysis indicated that seven parameters difered signiicantly between the two groups. Binary logistic regression analyses showed that the rate of gross hematuria was signiicantly higher(P = 0.042, Exp[B] = 7.889) and the rate of fatty iniltration of the Retzius space was signiicantly lower(P = 0.006, Exp[B] = 0.028) in patients with urachal carcinoma than in those with benign urachal masses. Gross hematuria and fatty iniltration of the Retzius space may be indications of malignant and benign urachal masses, respectively.

URACHAL CARCINOMA IN BLADDER

Objective: To investigate the clinicopathologic features and diagnostic criteria of urachal carcinoma in the bladder. Methods: Seven cases of urachal carcinoma in the bladder were analyzed retrospectively. Results: All the tumors were found locating in the dome of bladder. Of them, 4 were mucinous adenocarcinoma, one was well differentiated papillary enteric adenocarcinoma, one was well differentiated squamous carcinoma, and one was neuroendocrine carcinoma. Cystomorphous urachal remnants were found in 4 cases. The main complaint was hematuria and all patients underwent partial excision of bladder and urachus. Conclusion: Mucinous adeno-carcinoma is the main histo-pathological type, and cystomorphous urachal remnants are often accompanied with urachal carcinoma in the bladder. The key diagnostic criteria of urachal carcinoma in bladder are site and histopathology. And to examine the specimens carefully to find the urachal remnants is important.

Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus:A case report

BACKGROUND Symptomatic urachal anomalies are rare disorders.The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life.However,recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management.In this case,we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.CASE SUMMARY Female baby A,weighing 2.88 kg at 38^(+5) wk of gestational age,was referred to the hospital because of a red,swollen umbilicus approximately 2 cm×2 cm in size with yellow purulent exudate.Through physical and ultrasound examination,the baby was finally diagnosed with a urachal anomaly.We first used oxacillin to prevent infection for 3 d.On the 4^(th) day,microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus(MRSA).We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing.After 5 d,the symptoms of the umbilicus disappeared,and we discontinued silver dressing application.On the 12^(th) day,umbilical exudate testing was negative for MRSA.On the 14^(th) day,the baby's blood testing showed a white blood cell count of 14.7×10^(9)/L,neutrophil percentage of 27.8%,and C-reactive protein level of 1.0 mg/L,suggesting that the infection had been controlled.We stopped treatment,and the baby was discharged with no complications.In this case,the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods,which was a different course from that of some other urachal remnant cases.CONCLUSION Anomalies that do not connect with the bladder can be treated with nonoperative management,including application of conservative antibiotics and local intervention with silver-based dressings.Silver sulfate dressings are absolutely safe for neonates with judicious use,and they play an established role in preventing infection without resistance,which is a common problem with other antibiotics and antiseptics.

Primary urachal adenocarcinoma: a rare case report

Primary urachal carcinoma is a very rare cancer with a poor prognosis.It generally presents as a highgrade,high-stage tumor,and in most cases the patient has developed regional or distant metastasis at the time of presentation.Here,we report a very interesting case of primary urachal adenocarcinoma with signet ring cell carcinoma in a 58-year-old male who presented with a lower abdominal mass and discomfort.In this case,urachal carcinoma was successfully treated with surgery using an extended partial bladder cystectomy approach with excision of the urachal mass and umbilicus.The patient also underwent systematic chemotherapy with 5-fluorourical and cisplatin.During the 12-month follow-up period,the patient did not experience recurrence or metastasis.Overall,we found that an organ preserving extended partial cystectomy along with chemotherapy was an optimal treatment method that helped improve the patient's quality of the life with no recurrence of cancer so far.