臍尿管結石: 病理報告

陳世亮、張廷瑞、許智凱

台南市立醫院 泌尿科

Shih-Liang Chen, Ting-Jui Chang, Chih-Kai Hsu

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Background: Urachus is a tubular structure lined between fetal bladder and umbilicus and is susceptible for complete or partial involution after birth. Persistence of the urachus results in several anomalies, such as patent urachus, vesicourachal diverticulum, urachal sinus, cysts, and in rare occasion multiple urachal remnants. Also some complication like infection, umbilical polyps and stone formation can originate. Here we presented with case of urachus remnants with stone formation.

Case report: The 62 year old male patient complained for lower abdominal pain and urinary frequency for two weeks. Urinary analysis reported hematuria without pyuria. KUB revealed single bladder stone 1.5 x 1.5 cm. Cystosopy was performed and showed a pendulous like bladder stone connects with urachus. Cystolitholapaxy was done for bladder stone management and urachus remnants was fulgurated using TUR. Six months later cystoscopy was repeated and not bladder stone was noted.

Discussion: The urachus is an embryonic connection between the allantois and the anterior part of the bladder dome. It lies between the medial umbilical ligaments. Urachus stone may develops due to urine stasis and infection. Urachal remnants are frequently accompanied by malformations of the urinary system, attention must be paid to locating these malformations. In the literature review of the urachus containing stones, the patients were 40 to 74 years old. Male patients were reported more frequently. The symptoms included lower abdominal pain, irritative voiding symptoms, and a palpable abdominal mass with or without umbilical discharge. Traditional management of this lesion includes radical excision of all urachal remnants with or without a cuff of bladder tissue. It can be performed with an open or laparoscopic approach.