Urachal Anomalies in Children

Failure of the urachus to regress completely results in anomalies that may be classified as patent urachus, urachal sinus, urachal cyst and bladder diverticula. The presenting symptoms of children with urachal anomalies are variable and uniform guidelines for diagnosis and treatment are lacking. The purpose of this study was to elucidate our conclusions regarding the presentation, diagnosis and treatment of urachal anomalies by reviewing our experiences. We retrospectively analyzed the records of 32 patients who were admitted for urachal anomalies from March 1995 to February 2005. The age distribution of these patients at presentation ranged from 1 day to 14 years old (median age 1 month) and they included 20 boys and 12 girls. The 32 cases comprised 13 cases of urachal sinus (40.6%), 10 urachal cyst (31.3%), and 9 patent urchus (28.1%). The presenting symptoms were umbilical discharge (14 patients), umbilical granuloma (8), abdominal pain and fever (3), fever (3), abdominal pain (2), and a low abdominal mass (2). In 30 patients ultrasonography was used for diagnosis and 2 patients with patent urachus were explored without using a diagnostic method. Twenty-three patients were confirmed by ultrasonography alone and 7 patients were examined using additional modalities, namely, computed tomography for 2 patients with an urachal cyst, magnetic resonance imaging for 1 patient with an urachal cyst, and fistulography for 3 patients with an urachal sinus. Excision was performed in 29 patients, and 3 patients were conservatively managed. Urachal anomalies in children most frequently presented in neonates, and the most common complaint was umbilical discharge with infection. Urachal anomalies can be diagnosed by a good physical examination and an appropriate radiographic test, and ultrasound was found the most useful diagnostic method. Complete surgical excision of an urachal anomaly is recommended to avoid recurrence, and even, though rare, carcinoma development.

Screening for Asymptomatic Bacteriuria in Korean Preschool Children / 대한비뇨기과학회지

PURPOSE: To determine the incidence of asymptomatic bacteriuria in Korean preschool children, we performed national survey. MATERIALS AND METHODS: We surveyed kindergardens in seven representative cities of Korea. Before performing urine culture, we selected children by urine dipstick screening method(leukocyte esterase and nitrite test). And we analysed the incidence according to sex, age and socioeconomic status. RESULTS: Total registered population was 2,239 children and male to female ratio was 1.16. Overall, asymptomatic bacteriuria was found in 1.03%(23 children). In the male the incidence was 0.3%(3 children) and in the female it was 2.0%(19 children). Less than 4 years old children showed higher incidence (2.9%) than those of any other age groups, such as, 0.5% in 4, 1.1% in 5 and 1.3% in 6 years old. High, middle and low socioeconomic status groups showed the incidence as 0%, 0.9% and 1.4%, respectively The number of leukocyte esterase positive children was 184(8.2%) and that of nitrite positive children was 115(5.1%). Among them urine culture was performed in 175children and 23 children showed significant bacteriuria(colony count> 100,000/ml), so predictability of asymptomatic bacteriuria by dipstick test was 13.1% Radiologic study was performed in 9 children who had bacteriuria, but none of them showed urological abnormalities. CONCLUSIONS: From the above data, we found that asymptomatic bacteriuria is more common in female, younger age and lower socioeconomic status among the Korean preschool children. Considering cost-benefit aspects of the screening for asymptomatic bacteriuria, however, we should re-evaluate the necessity of our study on these particular age groups.