Introduction and Objectives
Urachus is a musculofibrous band extending 3 cm above the bladder dome to the umbilicus. Urachus is between transversalis fascia and peritoneum and epithelial canal persistent in 70% of adults. The urachus develops into the median umbilical ligament from bladder to umbilicus. Primary adenocarcinoma of the bladder and urachus are extremely rare about 0.5–2% of all bladder malignancies and urachal carcinoma represent 10% from all bladder adenocarcinoma. Patient with urachal carcinoma has symptoms of dysuria, haematuria, abdominal pain, umbilical discharge and as in one of our cases with periurachal abscess between transversalis fascia and peritoneum.
Material and Methods
We analyzed bladder carcinoma from 1989–2009 in our hospitals and found 3 cases of urachal adenocarcinoma in 2 male patients and one female. Male patients were 56–59 years old and female patient was 64 years old. All of them had adenocarcinoma and the female patient had symptoms of abdominal pain and hematuria, male patients had hematuria mucinous secretion, omphalitis with abscess between peritoneum and transversalis fascia.
All patients had worked up by cystoscopy, CT scan and physical examination for diagnosis and done on 2 patients one male and one female partial cystectomy extended from bladder to umbilicus removal of umbilicus and posterior rectal fascia. The third male patient who was presented with umbilical discharge and paraurachal abscess first was done incision with drainage and 6 weeks later partial cystectomy with extended resection of urachus and peritoneum and on bladder apex and urachus found mucinous adenocarcinoma. This patient had postoperative radiation and treatment for obstructive lower urinary symptoms.
Primary adenocarcinoma of bladder and urachus are extremely rare of all bladder malignancies and most of them had different clinical manifestation. Urachal carcinomas are 90% adenocarcinoma and 70% are mucinous positive. Partial extended bladder resection is always recommended with postoperative chemotherapy with irinotecan, 5 fluorouracil/leucovorin because 90% of these carcinomas are adenocarcinoma.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.