The purpose of these serial cases was to report the diagnostic and therapeutic features of urachal fistulas at Yalgado Ouedraogo teaching Hospital. We have reported retrospectively two cases of urachus fistula at the Surgery Department of Yalgado Ouedraogo Teaching Hospital in Ouagadougou. The parameters studied were sex, age, reason for consultation, clinical and paraclinical signs, treatment, length of hospital stay, delay of urinary catheterisation and evolution. Two serial cases of urachal fistula were reported, one 14 years old female patient and a 32 years old male patient. Clinical signs were marked by urine flow through the umbilicus. The diagnosis was made by fistulography in one case and during surgery for the second case. The treatment was surgical and consisted of laparotomy followed by removal of the urachal fistula from bladder. The urinary catheter was removed after 10 days. The postoperative course for the two patients was uneventful.
Urachal fistula is characterized by the non obliteration of primitive urachus on its entire path and therefore an interconnection between umbilicus and bladder lasting after birth [
It is about a 14 years old girl received in September 2017. She had involuntary urinary leakage through the umbilicus that had started one week after she was born and then stopped spontaneously. At the age of 7 years, she reported to her parents either a stench or a dampness of her umbilicus that apparently did not worry them. The persistence of the symptomatology led her to be referred to the surgery department for better care. The clinical examination highlighted a moist umbilicus with urine stink and a hole barely catheterizable. Blood test with complete blood count (CBC) showed 13 g/dl of hemoglobin and 7500/mm3 of WBC. Fistulogram performed with the retrograde urography confirm the diagnosis of urachal fistula (
It is about a 32 years old young adult, received for involuntary urinary leakage through the umbilicus and a peri-umbilical, oozing and pruritic ulceration evolving since childhood. This lesion had been neglected until June 2016 when the pruritus and the smell became unbearable. He consulted several times in peripheral health centers where two debridements were performed. The post debridement evolution was marked by the emphasis of urinary leakage.
The physical examination showed an ulcero-necrotic peri-umbilical lesion from where the pelvic pressure lets out a citrin liquid. The abdominal ultrasound
pointed communication of bladder roof and the umbilicus. The abdominopelvic scan and the fistulogram could not be realized for lack of financial resources. After normal blood test, a laparotomy was suggested. The exploration pointed out a tract measuring one (01) centimeter in diameter and 10 cm long linking the bladder to the umbilicus (
Urachus is an embryonic remnant derived from the allantois that comes in the form of an obliterated fibrous cord linking the bladder dome to the umbilicus [
1) The urachal fistula (48%), is a complete communication between bladder and umbilicus;
2) The urachal cyst (31%) is a cavity leaning on the urachal channel between the umbilicus and the bladder;
3) External sinus of urachus (18%) is an expansion of the upper end of the urachus;
4) Vesico-urachal diverticulum (3%) is an obliteration defect of the bladder part;
5) Alternated drainage sinus, unusual, is an obliteration defect, sometimes of the umbilicus part, sometimes of the bladder part.
According to the literature, urachal fistulas’ frequency is inconstant. Urachal fistula is the most common of urachal abnormalities according to Renard O. [
malformations. In Senegal, Ndour O. [
In France, Renard O. discovered that the diagnosis of urachal fistula is made during the neonatal period [
In our study, we noticed that the urine leaks through the umbilicus and its dampness were the main reasons of consultation. Mesrobian [
In our serie we did not get any associated malformations. On the other hand the Prune-Belly syndrom and posterior urethral valves were associated with urachal fistula [
The treatment of urachal fistulas is surgical according to Blichert [
Our patient stayed at the hospital for 4 days. Okegawa and al. [
In our serie the mortality was zero. Chances of mortality are even higher due to the complications and especially the malignant degenerescence [
Urachal fistulas are rare in our department. The umbilical flow is the clinical sign faced. Fistulography is a tool helping to establish the diagnosis. The cure must be surgical. The antenatal ultrasound might help to diagnose and to permit an early management of that pathology.
Consents of the patients were obtained before publication of this article.
The authors declared that there is no conflict of interests regarding the publication of this paper.
Yaméogo, C.A.M.K., Zida, M., Ouattara, A., Doamba, R., Ky, B., Zongo, K.D. and Kaboré, F.A. (2018) Urachus Fistula about Two Cases in Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina-Faso). Open Journal of Urology, 8, 193-198. https://doi.org/10.4236/oju.2018.86021