Treatment of Urachal Cyst
Complete surgical excision with en-bloc resection of the entire urachal ligament, including the umbilicus and bladder cuff, is the definitive treatment for all urachal cysts in adults. 1
Rationale for Surgical Excision
The National Comprehensive Cancer Network mandates complete surgical excision for all symptomatic or discovered urachal remnants to prevent two critical complications 1:
- Recurrent infection - the most common complication when urachal cysts are left untreated 2, 3
- Malignant transformation - retained urachal remnants carry a risk of developing urachal carcinoma, which has a worse prognosis than conventional bladder cancer and does not respond to standard urothelial chemotherapy 1, 4
Surgical Approach
Laparoscopic excision is the preferred surgical method for managing benign urachal cysts, offering comparable outcomes to open surgery with significantly reduced morbidity 5, 6:
- Port placement: Typically requires 2 ports of 10 mm and 1-2 ports of 5 mm 5
- Surgical technique: The urachus and medial umbilical ligaments are divided at the umbilicus cephalad to the cyst, then the entire specimen (urachus, cyst, and medial umbilical ligaments) is separated from the bladder dome with or without bladder cuff and removed intact 5
- Operative time: Averages 150-210 minutes 5
- Hospital stay: Typically 1-4 days 5
- Recovery: Patients resume normal activity within 2 weeks 5, 6
Critical Management Pitfalls
Incomplete excision must be avoided - any retained urachal tissue carries ongoing risk of malignant transformation 1. The resection must include:
- The entire urachal ligament from umbilicus to bladder
- En-bloc removal with umbilicus
- Bladder cuff excision 1
Management of Infected Urachal Cysts
A staged approach is recommended when infection is present 2:
- Initial antibiotic therapy to control acute infection 2
- Delayed complete surgical excision after infection resolution 2
This staged approach reduces perioperative complications while ensuring definitive treatment 2.
Follow-up Considerations
Pathological evaluation should confirm benign tissue in all excised specimens 5. The laparoscopic approach provides excellent diagnostic and therapeutic capability, particularly valuable in patients with acute presentations or unclear clinical pictures 3.