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 uncomfortable 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 dry out for a long time. Despite the asymptomatic course, the cavity contains pathogenic exudate, and under certain circumstances, septic complications may develop.
Urachus cyst in men, what is it?
In urology, education is considered as an intrauterine deviation of the urinary system. Urachus - the urinary duct in the embryo, located between the peritoneum and the transverse connective tissue membrane of the abdomen, which connects the bladder and navel. Fetal urine is excreted through the duct into the amniotic fluid. From the 20th week of embryonic development, the fusion of the duct begins, ending by the time of birth. But in a numbercases, incomplete obliteration occurs, resulting in the formation of anomalies.
- Umbilical fistula - an open part of the duct located in the navel.
- Vesico-umbilical fistula - the urachus remains open, the obliteration process, for some reason, did not occur.
- Diverticulum of the bladder - cleft of the anterior part 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. Exudate, mucus, urine, and original feces accumulate in the residual cavity. The cyst may not change in size for a long time and does not disturb in any way. With such a course, pathology is detected already in adulthood.
The cyst can grow to the size of a man's fist. The cavity is an extraperitoneal mass that, if infected, can rupture, leading to peritonitis.
According to ICD 10, the urachus cyst has the code Q64.4 and refers to anomalies of the urinary duct. The cavity in most cases is closed, sometimes it communicates with the bladder through a fistulous tract.
Causes of urachus cysts in men
The factors influencing the formation of a cavity are not fully understood. It is only known that the pathology is non-hereditary, i.e. if a parent has an anomaly, then the probability of its development in a child is negligible.
Urachus cyst in men - what is it? In fact, this is an unclosed median place of the urinary duct. Similar cysts form when the umbilical and vesical ends of the lumencloses and the intermediate part remains open.
Urachal remnant is diagnosed in 1.03% of the population. Very often, the duct becomes completely closed after birth until the age of four. In adult men, a cyst is detected when a patient presents with characteristic symptoms associated with infection.
How the disease manifests
With a small urachus cyst, symptoms may not be observed at all for a long time. The mass is usually discovered incidentally during a physical examination.
The clinical picture changes if an infection enters the cavity. The exudate inside the cyst becomes purulent, the inflammatory process progresses. Bacteria can get inside in two ways:
- Exogenous - pathogenic microorganisms penetrate into the urachal lumen through a fistula or as a result of a violation of the integrity of nearby tissues.
- Endogenous - bacteria enter the cavity through a nearby infected organ (usually the bladder with cystitis).
The 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 swelling in the lower abdomen. The inflamed area hurts, the pain increases with pressure.
- A large pathological cavity compresses the bladder. Men complain of difficult and painful urination. Pain extends to the groin.
- Bigcysts compress the intestines, as a result of which disorders of the gastrointestinal tract develop. Disorders are accompanied by bloating, belching, nausea, gas formation. If timely measures are not taken, more severe disorders such as diarrhea or constipation occur.
- Inflammation of the cyst is often accompanied by high temperature, fever.
What could be the complications
The main clinical manifestation of the inflammatory process is pain in the abdomen. Men associate such symptoms with poisoning, overeating, not even suspecting the real causes of the clinical picture. Patients eliminate symptoms on their own, without even trying to find the cause of their occurrence. Meanwhile, inflammation progresses, the cavity increases in size, and the risk of complications increases.
- Spread of infection to the organs of the genitourinary system. This threatens the development of new pathologies, which are quite difficult to treat.
- Infection of the kidneys, with subsequent disruption of the functionality of the urinary system.
- Development of an abscess in the abdominal cavity, peritonitis.
- A festering cyst can break through, and the contents come out into the abdominal cavity. Purulent exudate will penetrate the tissues through the blood and quickly cause sepsis.
Some experts believe that in certain cases, surgery for urachus cysts in men could have been avoided if patients had sought help before the onset of complications.
How the diagnosis is made
KUnfortunately, pathology in men in adulthood is more often diagnosed when they are admitted in a serious condition. When a cyst is perforated, a conclusion can only be made using a laparoscopic or laparotomy study. If the patient is not in an emergency, then the diagnosis is carried out as follows.
- Collecting an anamnesis by the surgeon. The doctor collects information about the duration of the onset of symptoms and their nature.
- Physical examination. The doctor examines and probes the alleged site of inflammation between the umbilical ring and the upper pubic area. Some patients may experience yellowish pus in the umbilicus that oozes out when pressure is applied, sometimes a small amount of bloody discharge comes out with the exudate.
- Ultrasound of urachus cysts allows you to determine the exact location of the formation, size. With the help of ultrasound, the density of the contents of the pathological cavity, the thickness of its walls is estimated. Based on such data, it is possible to approximately estimate the likelihood of a cyst rupture in the near future.
- Cystogram. A dye is injected through the catheter into the bladder, after it has spread into the cyst, it is assessed whether the duct communicates with the bladder.
- Fistulography is done in the presence of a fistulous tract. The procedure determines the direction of the fistula, the presence of branches, length, connection with adjacent structures.
It is important to make a differential diagnosis of urachus cyst from umbilical hernia, bladder diverticulum cyst.
Effectiveness of drug treatment
When a cyst is detected during a standard medical examination, the surgeon asks the patient about the presence of any symptoms. If education does not bother a man, and additional diagnostics did not reveal complications, then therapeutic measures for pathology are not carried out. In medical practice, enough cases have been identified when patients lived with a cavity until old age, and it did not bother them.
It is completely pointless to treat an infected cyst with medicines. Antibacterial therapy eliminates the pathogen, but the contents of the cavity remain, and the fluid itself is pathogenic, at any time it can come out and cause serious complications. The only treatment for symptomatic urachus cysts is surgery. Surgical intervention allows not only to completely eliminate the pathological process, but also to avoid relapses.
Surgical treatment of urachus cysts
Infected pathological cavities with suppuration require surgical intervention. When abscess formation is performed, an immediate opening is performed with drainage of the cavity. After that, a course of antibacterial drugs is prescribed, most often "Dicloxacillin" 250 ml per day orally. In the cold period, extraperitoneal excision of the pathological cavity is performed.
Urachus cyst removal can be done in two ways: laparotomy or laparoscopy. The latter is used only in the absence of complications and non-progressive inflammatory process.
Laparotomy is performed under general anesthesia. The tissues of the skin and muscle layers of the peritoneum are dissected with a scalpel. If a cystlarge and with signs of suppuration, it is opened and the purulent contents are removed, after which its walls are excised. If the pathological formation is small, the urachus is excised along with the cyst.
Laparoscopic surgery
Laparoscopy is always a planned operation. Unfortunately, due to the large number of contraindications, this method of treatment is rarely used. Although the method has several advantages:
- possibility of operation under local anesthesia;
- short recovery period;
- Laparoscopy of urachus cyst in men does not leave scars;
- probability of complications is almost zero.
Laparoscopic surgery is performed by two people - a surgeon and his assistant. On the abdomen, 3 ports (holes) with a diameter of 5 mm are performed. The first in the upper middle part of the abdomen for insertion of the laparoscopic Grasper, the second in the left upper part of the abdomen and the third above the right upper part of the abdomen. With the help of endoclips, the urachal cyst and fibrous tract are removed. A sample of the cyst is sent for histology. The operation takes about an hour.
Forecast
After removing the cyst, the problem is completely solved. For a period of time, a man experiences pain. To eliminate them, "Acetaminophen", "Motrin" are prescribed. The prognosis of treatment is favorable. When the urachus is removed, the risk of infection in the future is eliminated. It is believed that the remains of the embryonic urinary duct may be a site for the development of cancer, but so far this is only an opinion.
Prevention
According to ICD cysturachus refers to malformations of the urinary duct. But the causes of the anomaly are unclear. Therefore, prevention of complications of cystic formation should be carried out. Men, with any unpleasant manifestations, should undergo a comprehensive examination. If a pathological cavity is detected, discuss with the doctor the advisability of its excision 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 lies in the fact that patients do not seek help immediately, trying to eliminate the symptoms. At the first signs that characterize a violation of the state of he alth, it is necessary to seek the advice of a doctor. A planned operation guarantees a short period of rehabilitation and recovery. If you delay going to the doctor, serious complications can develop, which are a threat not only to he alth, but also to life.
