賴宗豪¹、林雍偉¹、溫玉清¹、許軒豪¹

¹台北市立萬芳醫院 泌尿科

Chung-Howe Lai¹, Yung-Wei Lin¹, Yu-Ching Wen¹, Syuan-Hao Syu¹

¹ Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

 

Urachus is the embryological remnant of the allantois that connects the fetal bladder to the umbilicus. It usually obliterates in the 5th month of gestation, giving rise to the median umbilical ligament. An urachal remnant is a rare anomaly in adults, with a heterogenous presentation. We hereby report a case of urachal cyst with rare location and presentation. This 50-year-old lady presented with frequency and occasional painless gross hematuria. Cystoscopy revealed a protruding mass over dome with normal mucosal contour. CT imaging found a tumor over bladder dome, size 1.8cm, with mostly intravesical portion. Differential diagnosis included bladder leiomyoma, which is also a very rare benign bladder tumor. Surgical treatment was proceeded with a novel approach – transurethral resection (TUR) assisted laparoscopic resection. Bladder dome and anterior wall was exposed but the tumor couldn’t be seen transperitoneally. TUR was then carried out to partially enucleate the tumor until the bladder wall was very thin. Under resectoscopic light guidance, the tumor was then fully dissected from the bladder wall via transperitoneal approach. The bladder defect was then closed in a dual layer fashion. Histo-pathological examination of the tumor validated the presence of an urachal cyst lined with simple flattened to cuboidal epithelium within the bladder wall, located between the muscularis mucosae and muscularis propria. In conclusion, complete excision of the cyst is the treatment of choice. Laparoscopic excision is increasingly being used with results comparable to open surgery with the advantages of a minimally invasive approach. TUR-assistance is a novel technique which can help us to confirm the specific site for excision of rarely located tumors with maximal bladder preservation.