[Surgical experience with urachal carcinoma].

Servicio de Urología Oncológica, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., Mexico.
Cirugia y cirujanos (Impact Factor: 0.32). 01/2009; 77(1):33-8.
Source: PubMed

ABSTRACT Urachal carcinomas are rare neoplasms that constitute <1% of bladder tumors. We undertook this study to describe the medical and surgical experience of urachal carcinomas treated in our hospital.
We carried out a retrospective, descriptive and observational study. Clinical files were reviewed of patients with diagnosis of bladder cancer and who were operated on with radical cystectomy with urinary substitution and extended partial cystectomy, selecting those patients with pathological report of urachal carcinoma. The study was conducted from January 1994 to May 2007 analyzing the following data: age, sex, symptoms, diagnostic methods, surgical approach, complications and disease-free survival.
Of the 306 patients operated on with radical surgery for bladder cancer, only five patients (1.6%) had a diagnosis of urachal carcinoma. There were three (60%) men and two (40%) women, with a median age of 61 years. Hematuria was the chief complaint in all cases and the reason why they were initially treated with ultrasonography (USG). In one case, tumor of the right ovary was documented and the patient underwent exploratory laparotomy and extended partial cystectomy. In the other four cases, tumor was reported in the dome of the bladder and for this reason cystoscopy and transurethral resection of the bladder (TURB) were done, confirming the clinical findings in addition to the pathology report suggesting urachal carcinoma. Computed tomography (CT) confirmed the tumor in urachal topography, reporting a Sheldon clinical stage IIIb in three patients and stage IVa in one patient. This was the reason for the Studer-type orthotopic bladder substitution. Currently, four patients are being followed-up without recurrence, reporting only one death related to the disease.
Urachal carcinomas are rare tumors with an incidence of 1.6% in our studied population. Symptoms in most cases are similar to those of bladder pathology origin. The surgical approach and procedure described here provide the best opportunity for disease-free survival.

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    ABSTRACT: Urachal carcinoma (UrC) is a rare but highly malignant epithelial cancer and commonly found in the urachal remnant which connects the dome of the bladder to the umbilicus via the ligamentum commune. Because of the specificity of the tumor location and its rarity, the diagnosis of UrC is often difficult. Although surgery is the treatment of choice for UrC, it still has a high incidence of local recurrence and distant metastasis and there are few modestly standard chemotherapy regimens for these patients (response rate 30-40%). Thus, the treatment of local recurrence and distant metastasis of UrC following surgery has been a challenge. We review the clinical diagnosis and therapy of UrC and factors related to its prognosis.
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