A cyst is a pathological cavity that can form in any organ or even tissues. Depending on the location, size and type, the neoplasm can be inconvenient or accompanied by severe pain. Regardless of the symptoms, the cavity seriously impairs the functionality of the organ. Urachus cyst in men occurs during ontogenesis and may not wither for a long time. Despite the asymptomatic course, the cavity contains pathogenic exudate, and septic complications may develop in certain circumstances.
Urachus cyst in men, what is it?
In urology, education is considered as an intrauterine deviation of the urinary system. Urachus is the urinary duct at the embryo located between the peritoneum and the transverse connective tissue membrane of the abdomen, which connects the bladder and the navel. Through the duct of the urine of the fetus is excreted in the amniotic fluid. From the 20th week of embryonic development, duct fusion begins, ending at the time of birth. But in some cases incomplete obliteration occurs, as a result of which anomalies form.
- The umbilical fistula is the ungrown part of the duct located in the navel.
- Bubble-umbilical fistula - Urachus remains open, obliteration process, for some reason did not occur.
- Bladder diverticulum - non-closure of the anterior section of the bladder in the part that connects to the duct.
- Urachus cyst in men - non-closure of the middle part of the embryonic urinary duct. In the residual cavity, exudate, mucus, urine, and original feces accumulate. A cyst may not change in size for a long time and does not bother. With this course, pathology is detected already in adulthood.
The cyst may increase to the size of a male fist. The cavity is an extraperitoneal mass, which in case of infection can burst, which will lead to peritonitis.
According to ICD 10, the urachus cyst has a code of Q64.4 and refers to abnormalities of the urinary duct. The cavity in most cases is closed, sometimes communicates with the bladder through the fistulous course.
Causes of Urachus Cysts in Men
The factors affecting the formation of the cavity are not fully understood. It is only known that the pathology is non-hereditary, that is, if the parent has an anomaly, then the probability of its development in the child is negligible.
Urachus cyst in men - what is it? In fact, this is the unclosed midline of the urinary duct. Similar cysts form when the umbilical and cystic ends of the lumen are closed, and the intermediate part remains open.
Urachial residue is diagnosed in 1.03% of the population. Very often, the duct overgrows completely after birth to four years of age. In adult men, a cyst is detected upon treatment of a patient with characteristic symptoms characteristic of infection.
How is the disease manifested?
With small sizes of the Urachus cyst, symptoms may not occur at all for a long time. Education is usually discovered by chance during a physical examination.
The clinical picture changes if an infection enters the cavity. The exudate located inside the cyst becomes purulent, the inflammatory process progresses. Bacteria can penetrate in two ways:
- Exogenous - pathogenic microorganisms penetrate the urachal lumen through the fistula or as a result of violation of the integrity of nearby tissues.
- Endogenous - bacteria enter the cavity through a nearby infected organ (usually the bladder with cystitis).
An inflamed cyst rapidly increases in size, and the pathological process itself is accompanied by the following clinical manifestations.
- In the area of the cyst there is a slight bloating in the lower abdomen. The sore spot hurts, the pain intensifies with pressure.
- A large pathological cavity compresses the bladder. Men complain of difficulty and painful urination. Pain spreads to the inguinal region.
- Large cysts squeeze the intestines, as a result of which dysfunctions of the gastrointestinal tract develop. Disorders are accompanied by bloating, belching, nausea, gas formation. Failure to take timely measures will result in more severe disorders, such as diarrhea or constipation.
- Inflammation of the cyst is often accompanied by fever, fever.
What can be the complications
The main clinical manifestation of the inflammatory process is abdominal pain. Men associate these symptoms with poisoning, overeating, not even suspecting the real causes of the clinical picture. Patients independently eliminate the symptoms, without even trying to find the cause of their occurrence. Meanwhile, inflammation progresses, the cavity increases in size, and the risk of complications increases.
- The spread of infection to the genitourinary system. This threatens the development of new pathologies, which are quite difficult to treat.
- Infection of the kidneys, followed by a violation of the functionality of the urinary system.
- The development of an abscess in the abdominal cavity, peritonitis.
- A festering cyst can break through, and the contents exit into the abdominal cavity. Purulent exudate through the tissues will penetrate the bloodstream and quickly cause sepsis.
Some experts believe that in certain cases, surgery for a male urachus cyst could be avoided if patients sought help before complications occurred.
How is the diagnosis
Unfortunately, pathology in men in adulthood is more often diagnosed when they are received in serious condition. With perforation of the cyst, a conclusion can be made only with the help of a laparoscopic or laparotomy examination. If the patient is not in an emergency, then the diagnosis is as follows.
- Collection of a history by the surgeon. The doctor collects information about how long the symptoms appeared and their nature.
- Physical examination. The doctor examines and probes the alleged site of inflammation between the umbilical ring and the upper pubic zone. Some patients may experience yellowish pus in the umbilicus, resulting from pressure, sometimes a small amount of bloody discharge comes along with exudate.
- Ultrasound of the cysts of urachus allows you to determine the exact location of the formation, size. Using ultrasound, the density of the contents of the pathological cavity and the thickness of its walls are estimated. Based on such data, it is possible to approximately estimate the likelihood of a cyst rupture in the near future.
- The cystogram. A dye is injected into the bladder through a catheter; after its spread into the cyst, it is assessed whether the duct is being communicated with the bladder.
- Fistulography is done in the presence of fistulous passage. The procedure determines the direction of the fistulous course, the presence of branches, length, connection with adjacent structures.
It is important to conduct a differential diagnosis of a urachus cyst from an umbilical hernia, a diverticulum cyst of the bladder.
Drug Treatment Effectiveness
If a cyst is detected during a standard medical examination, the surgeon asks the patient about the presence of any symptoms. If the man is not bothered by education, and additional diagnostics have not revealed any complications, then therapeutic measures for pathology are not carried out. In medical practice, enough cases have been identified when patients lived with the cavity until they were old, and it did not bother them.
It is completely pointless to treat an infected cyst with medications. Antibacterial therapy eliminates the pathogen, but the contents of the cavity remain, and the liquid itself is pathogenic, at any time it can come out and cause serious complications. The only method of treating symptomatic cysts of urachus is surgery. Surgical intervention allows not only to completely eliminate the pathological process, but also to avoid relapses.
Surgical treatment of Urachus cyst
Infected pathological cavities with suppuration require surgical intervention. When abscess formation is carried out an immediate opening with drainage of the cavity. After prescribed a course of antibacterial drugs, most often "Dicloxacillin" at 250 ml per day orally. In the cold period, extraperitoneal excision of the pathological cavity is performed.
Urachus cyst removal can be carried out in two ways: laparotomy or laparoscopy. The latter is used only in the absence of complications and a non-progressive inflammatory process.
Laparotomy is performed under general anesthesia. Tissues of the skin and muscle layers of the peritoneum are dissected with a scalpel. If the cyst is large and with signs of suppuration, it is opened and purulent contents are removed, after which its walls are excised. If the pathological formation is small, excise the urachus with a cyst.
Laparoscopic surgery
Laparoscopy is always a planned operation. Unfortunately, due to the large number of contraindications, such a method of treatment is rarely resorted to. Although the method has several advantages:
- the possibility of surgery under local anesthesia;
- short recovery period;
- with laparoscopy of a urachus cyst in men, there are no scars;
- the likelihood of complications is almost zero.
Laparoscopic surgery is performed by two - the surgeon and his assistant. On the stomach perform 3 ports (holes) with a diameter of 5 mm. The first in the upper middle abdomen for the introduction of a laparoscopic grasper, the second in the upper left abdomen and the third above the right upper abdomen. Using the endoclips, the urachial cyst and fibrous tract are removed. A sample of the cyst is sent for histology. The operation lasts about an hour.
Forecast
After removal of the cyst, the problem is completely resolved. For some period, a man experiences pain. To eliminate them, Acetaminophen, Motrin are prescribed. The prognosis of treatment is favorable. Removing urachus eliminates the risk of future infection. It is believed that the remains of the embryonic urinary duct may be the place for the development of cancer, but so far this is only an opinion.
Prevention
According to the ICD, the urachus cyst refers to malformations of the urinary duct. But the causes of the anomaly are unclear. Therefore, prophylaxis of complications of cystic formation should be carried out. Men, for any unpleasant manifestations, should undergo a comprehensive examination. If a pathological cavity is detected, discuss with the doctor the feasibility of excising it in order to eliminate the likelihood of complications.
Conclusion
Urachus cyst in men is not a common disease. The vast majority have never even heard of such a pathology. The main danger is that patients do not seek help immediately, trying to eliminate the symptoms. At the first signs characterizing a violation of the state of health, it is necessary to consult a doctor. A planned operation guarantees a short rehabilitation period and recovery. Serious complications may develop when the call to the doctor is delayed, which is a threat not only to health but also to life.