Congenital urachal anomalies

Last revised by Dr Matt A. Morgan on 25 May 2021

Congenital urachal anomalies are a spectrum of potential anomalies that can occur due to incomplete involution of the urachus.

A urachal remnant occurs in approximately 1 in 5000 patients.

The urachus connects the dome of the bladder to the umbilical cord during fetal life and is located behind the lower anterior abdominal wall and anterior to the peritoneum in the space of Retzius.

By birth, the urachus is obliterated and becomes a vestigial structure known as the median umbilical ligament (not to be confused with the medial umbilical ligament, which is a separate structure that lies laterally to the median umbilical ligament).

In the absence of complete obliteration, the urachus persists in a number of configurations depending on the location and degree of obliteration. 

There are four types of congenital urachal remnant anomalies. They are:

Congenital urachal remnants predispose to infection from urinary stasis and over a long period the remnant may develop malignancy (e.g. adenocarcinoma).

Treatment is not standardized. Some recommend surgical excision of the urachus if a remnant anomaly is present.

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Cases and figures

  • Figure 1: patent urachus
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  • Figure 2: umbilical-urachal sinus
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  • Figure 3: urachal cyst
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  • Figure 4: vesicourachal diverticulum
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  • Case 1: patent urachus
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  • Case 2: urachal cyst
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  • Case 3: prominent median umbilical ligament
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  • Case 4: infected patent urachus
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  • Case 5: infected urachal cyst
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