URACHUS

Urachus is a fibromuskuler cord

located on the anterior extraperitoneal
tissue in Retzius space (between the
fascia
transverlis
anterior
and
posterior parietal peritoneum side).
Urachus is normal in embryonic life
and experience obliteration with 32
weeks of gestation, leaving a fibrous
band in adults known as umbilical
ligament media.

In histology urachus is fibromuskuler tube consisting

of three distinct layers, namely;
Epithelial duct with transitional epithelium (70%) or
columnar epithelium (30%),
Submukosal connective tissue layer; and
The outer layer of smooth muscle that has continuity
with detrusor muscular.
Defects in obliteration of the urachus cause
congenital abnormalities such as fistula urachus,
urachal sinus, urachal diverticulum and urachal cyst.
The rest of urachus can provide a variety of problems
not only in infants and children but also in adults.

EMBRYOLOGY
Urachus is an embryological remnant of involution allantoic and ventral
cloaca, but still there is controversy regarding the definite contribution of
allantoic and ventral cloaca to the formation of urachus. Allantoic himself
appeared on day 16 after conception as the bag is empty in the caudal wall
of the yolk sac, connecting the urogenital sinus with the umbilicus, serves
as the bladder in early embryonic blood formation and the formation of the
definitive kidney. Normally, part ekstraembrional allantoic degenerated
during the second month of gestation. Sometimes, the rest of the allantois
was found in the proximal umbilicus and can be seen between umbilical
artery on pathologic examination of the fetus during this grestasional.
Intraembrionik allantoic forming part of the umbilicus higga relation to the
urogenital sinus. Between 4-5 months gestational, bladder begins to
experience desensus forward under the pelvic cavity and allantoic involution
induces, causes the increased length of the umbilical cord and allantoic
undergo involution form the urachus. After birth, the urachus into a fibrous
band in adults known as umbilical ligament media.

Disorders in Urachus
Urachus anomalies caused by the failure of obliteration of the
lumen of the urachus with the underlying etiology both
genetically and the molecular level is still unknown. This
obliteration defects give variations disorder that causes
permanent relationship between the bladder, urachus and the
umbilicus. By because rare cases, abnormalities of the rest of
urachus often confused with dimisdiagnosis and midline regions
intraabdominal disorders and disorders of the pelvic cavity.
Formation desensus urachus directly related to the bladder.
Tergantunggnya desensus process is more often accompany
patent urachus in the appeal of bladder outlet obstruction.
Urachus anomalies kongentinal twice more often found in men
than women and is known four types of disorders, namely fistula
urachus, urachal cyst, sinus uracal and urachal diverticulum.

Fistula Urachus
Fistula occurs when the rest of the channels settled relationship
between bladder to the umbilicus due to the total failure of closure of
the epithelial line urachal canal, so that urine can flow out through
the umbilicus.
The cause still idiopathic but there are several theories that emerged,
namely intrauterine bladder obstruction theory, the theory of process
failures decrease urinary bladder in the pelvis and re-tubularization
theory.
On physical examination obtained drainage of fluid from the
umbilicus is continuous or intermittent flow increases when the
increase in intra-abdominal pressure such as crying, coughing and
straining. Additional symptoms that arise, such as enlargement or
edematous umbilicus, and slow healing of the umbilical cord.

Urachal Cyst
Urachal cyst occurs when Urachal
closing the umbilicus and bladder
area however, the area between the
two channels remain patent urachus.
Lumen is then filled the rest of the
liquid and form a cyst.

Urachal Sinus
Urachal sinus was found in 15% of
cases urachus anomalies. In urachal
sinus,
partially
covered
urachus
channel with the rest of the channels
open to the umbilicus. The distal
portion of the urachus filled by
epithelial cell desquamation, and there
was no correlation with urinary
bladder. Or it can also occur as a result
of the urachus cyst drainage opening

On physical examination, be found of the intermittent

drainage of the umbilicus (can be serous or
serosangiunous). Urachal sinus infection is often the cause
of the episode at the umbilicus, causing fluid drainage from
the umbilicus. Child will complain of swelling periumbilikal,
wet or humid umbilicus granulation tissue at the umbilicus.
Urachal diverticulum represents 3-5% urachal anomaly.
Diverticular sac vesikourachal is boils down to the apex of
the bladder caused by imperfect closure of the proximal
urachus. Generally, patients with diverticular vesikourachal
not give the complaint because the flow of urine to flow
diverticulum well as emptying the bladder.

Treatment
Surgical treatment is the central handling of
urachus anomalies, with the exception of a
patent urachus in neonates, which can be closed
when not occur spontaneously vesikaurinaria
obstruction, and diverticulum with a wide mouth.
Urachus abnormalities were indicated for surgery
is persistent urachus patent (because the risk of
recurrent infections, stone formation, persistent
drainage of fluid from the umbilicus, excoriation,
and pain), symptomatic urachus cyst (large or
infection), and symptomatic sinus urachus.