From the Research
The management of an infected urachal cyst typically involves a two-stage approach consisting of initial antibiotic therapy followed by surgical excision, with laparoscopic approaches being a safe and effective option, as reported in a case study published in the International Journal of Surgery Case Reports in 2018 1. The initial step in managing an infected urachal cyst is to administer broad-spectrum antibiotics to control the infection. Commonly used combinations include piperacillin-tazobactam (3.375g IV every 6 hours) or ceftriaxone (1-2g IV daily) plus metronidazole (500mg IV every 8 hours) for 5-7 days. In cases with abscess formation, percutaneous drainage may be necessary before definitive surgery. Once the infection is controlled, complete surgical excision of the urachal cyst and tract is recommended to prevent recurrence and the small risk of malignant transformation. This typically involves removing the cyst, the entire urachal tract from the umbilicus to the bladder dome, and a cuff of bladder if the tract is patent to the bladder. Laparoscopic approaches, as described in the study published in the International Journal of Surgery Case Reports in 2018 1, are increasingly used with good outcomes, though open surgery may be preferred for complex cases. Postoperatively, patients should be monitored for complications such as wound infection, bladder leakage, or fistula formation. Complete excision is crucial because partial removal carries a 30% risk of recurrence and continued risk of malignancy, which occurs in approximately 0.7% of urachal remnants in adults. Some studies, such as the one published in the Journal of Urology in 1997 2, suggest that a two-stage approach with initial drainage followed by elective excision may be a safe option, while others, like the study published in the Yonsei Medical Journal in 2006 3, compare the effects of two-stage and single-stage procedures. However, the most recent and highest quality study, published in the International Journal of Surgery Case Reports in 2018 1, supports the use of a staged approach with antibiotic administration followed by laparoscopic surgical excision.
Key points to consider in the management of infected urachal cysts include:
- Initial antibiotic therapy to control the infection
- Percutaneous drainage in cases with abscess formation
- Complete surgical excision of the urachal cyst and tract to prevent recurrence and malignant transformation
- Laparoscopic approaches as a safe and effective option
- Postoperative monitoring for complications such as wound infection, bladder leakage, or fistula formation. The study published in the International Journal of Surgery Case Reports in 2018 1 provides the most recent and highest quality evidence to support the management of infected urachal cysts.