Patent urachus repair

Definition

Patent urachus repair is surgery to repair a bladder defect. In an open (or patent) urachus, there is an opening between the bladder and the umbilicus that should not be there. An open urachus occurs mostly in infants.

Description

Children who have this surgery will receive general anesthesia (asleep and pain-free).

The surgeon will make an incision (cut) in the lower belly. Next the surgeon will locate the urachal tube and remove it. The bladder opening will be repaired, and the incision will be closed.

The surgery can also be done with a laparoscope, an instrument that has a tiny camera and light on the end.

• The surgeon will make three small incisions in the child’s belly. The surgeon will insert the laparoscope through one of these incisions and other tools through the other cuts.
• The surgeon uses the tools to remove the urachal tube and close off the bladder and area where the tube connects to the umbilicus.

This surgery can be done in children as young as 6 months.

Why the Procedure Is Performed

Surgery is recommended for a patent urachus that does not close after birth. If the urachal tube is not removed and closed:

• Your child has a higher risk for urinary tract infections.
• Your child has a higher risk for cancer of the urachal tube later in life.
• The urachus may also continue to leak urine.

Risks

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Infection
• Blood clots in the legs that may travel to the lungs

Additional risks for this surgery are:

• Bladder infection
• Bladder leaks -- if this happens, a catheter (thin tube) is inserted into the bladder to drain urine. It is left in place until the bladder heals

Before the Procedure

The surgeon may ask for your child to have:

• Ultrasound of the urachus with a sinogram. In this procedure, a radioactive dye is injected into the urachal opening.
• Kidney ultrasound
• VCUG (voiding cystourethrogram) a special x-ray to make sure the bladder is working
• A complete medical history and physical exam

Always tell your child’s doctor or nurse:

• What drugs your child is taking. Include drugs, herbs, vitamins, or any other supplements you bought without a prescription.
• About any allergies your child may have to medicine, latex, tape, or skin cleaner.

During the days before the surgery:

• About 10 days before the surgery, you may be asked to stop giving your child aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), warfarin (Coumadin), and any other drugs that make it hard for blood to clot.
• Ask the doctor which drugs your child should still take on the day of the surgery.

On the day of the surgery:

• Your child will probably not be able to drink or eat anything for 4 to 8 hours before surgery.
• Give your child any drugs the doctor said your child should have with a small sip of water.
• Your child’s doctor or nurse will tell you when to arrive at the hospital.
• The doctor will make sure your child has no signs of illness before surgery. If your child is ill, the surgery may be delayed.

After the Procedure

Most children stay in the hospital for just a few days after this surgery. Most recover rapidly. Children can eat their normal foods once they start eating again.

Before leaving the hospital, the nurse should teach you how to care for the wound or wounds. If Steri-Strips were used to close the wound, they should be left in place until they fall off on their own in about a week.

The doctor may give you a prescription for antibiotics to prevent infection and recommend safe medicine to use for pain.

Outlook (Prognosis)

The outcome is usually excellent.

References

Frimberger D, Kropp BP. Bladder anomalies in children. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 121.