What are the other Names for this Condition? (Also known as/Synonyms)

• Urachal Diverticulum
• Vesico-Urachal Diverticulum

What is Vesicourachal Diverticulum? (Definition/Background Information)

• The urachus is a tubular structure that forms during early fetal development. This structure connects the anterior portion (anterior bone) of the urinary bladder to the umbilicus. Usually, the urachus closes by week 12 of gestation, leaving behind a thick fibrous band. However, rarely, some portions of the urachus may not close completely, resulting in a variety of urachal abnormalities
• A Vesicourachal Diverticulum forms where the urachus fails to seal close to the urinary bladder, while the umbilical end is completely obliterated. This results in a blind tract originating from the bladder. This condition is usually asymptomatic; but, occasionally, it can become infected causing abdominal pain and drainage of infected material
• Even though Vesicourachal Diverticulum is a congenital occurrence; in many cases, it may remain symptomless and thus, may be undiagnosed throughout one’s life. When symptoms develop, they are known to do so frequently into one’s adulthood rather than during one’s childhood
• The signs and symptoms of Vesicourachal Diverticulum often arise due to infection and may include fluid discharge from the bladder and abdominal pain. There is an elevated risk for recurrent urinary tract infections
• Symptomatic Vesicourachal Diverticulum may be surgically resected, either through an open approach or a laparoscopy. The prognosis of isolated urachal anomalies (i.e., not associated with any other congenital conditions) is typically good with adequate treatment

There are five forms of congenital urachal remnant abnormalities, and these include:

• Alternating sinus of urachus (some experts recognize this as a type of umbilical-urachal sinus)
• Patent urachus
• Umbilical-urachal sinus
• Urachal cyst
• Vesicourachal Diverticulum

Among these urachal abnormalities, patent urachus is the only condition that predominantly presents symptoms following birth of the child (early infancy).

Who gets Vesicourachal Diverticulum? (Age and Sex Distribution)

• According to literature, Vesicourachal Diverticulum constitutes only between 3-4% of all congenital urachal abnormalities making it the rarest of the urachal remnant abnormalities
• The condition is more often seen in adults than children
• It can occur both in males and females
• No specific racial or ethnic group predilection is noted

What are the Risk Factors for Vesicourachal Diverticulum? (Predisposing Factors)

• Currently, no risk factors have been clearly identified for the formation of Vesicourachal Diverticulum

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Vesicourachal Diverticulum? (Etiology)

Before birth, the urachus is a primitive structure that connects the umbilical cord to the bladder in the developing baby. The urachus helps in removal of nitrogenous wastes from the fetus through the placenta via the umbilical cord. The remnant fibrous band of urachus is called the medial umbilical ligament.

• The urachus is generally between 3-10 cm in length and 1 cm in diameter. When the urachus disappears normally around the 12^th week of fetal development, a small fibrous cord (median umbilical ligament) remains between the bladder and the umbilicus
• The urachus normally disappears before birth; but occasionally, it remains even after the child is born. This can lead to urachal abnormalities such as Vesicourachal Diverticulum. The exact reason why this occurs is unknown
• In Vesicourachal Diverticulum, there is a communication between the urachal remnant and anterior bladder dome. This is because the distal end of the urachus fails to close i.e., at the bladder end, resulting in drainage of fluids into the bladder

What are the Signs and Symptoms of Vesicourachal Diverticulum?

Vesicourachal Diverticulum usually does not present any signs and symptoms in children. However, in adults, it may become infected and show signs and symptoms that may include:

• Abdominal pain
• Fever, due to infection
• If it is associated with urinary tract infections, then the following signs and symptoms may be noted:
  • Changes in urination frequency
  • Burning sensation or pain during urination
  • Fever and chills
  • Changes in urine smell and color
  • Sometimes, pain during sexual intercourse

It is reported that the opening that drains into the bladder is usually large in size, thereby resulting in a decreased frequency of symptoms and complications.

How is Vesicourachal Diverticulum Diagnosed?

When Vesicourachal Diverticulum is asymptomatic, it may be detected incidentally on ultrasound scans that are performed for other medical conditions. In other cases, the following tests and exams may be ordered to diagnose the condition:

• Physical examination and evaluation of medical history
• Ultrasound studies: Prenatal abdominal ultrasound may reveal associated fetal abnormalities, if any
• A voiding cystourethrogram (VCUG) is performed to look for urinary tract abnormalities
• Computed tomography (CT scan) or magnetic resonance imaging (MRI scan) of the affected region, if necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Vesicourachal Diverticulum?

• The complications of Vesicourachal Diverticulum may include a higher risk for recurrent urinary tract infections
• There is a small risk for urachal cancer; and in such cases, the entire urachus may be surgically removed
• Complications may occur with or without treatment, and in some cases, due to treatment also

How is Vesicourachal Diverticulum Treated?

The healthcare provider may recommend a ‘wait and watch’ approach for asymptomatic cases of Vesicourachal Diverticulum.

• In case of symptoms, surgical resection and removal of the urachal remnants, by either open surgery or a laparoscopic approach may be considered
• If there is an infection associated with Vesicourachal Diverticulum, then the infection is treated prior to any surgical corrections are undertaken

How can Vesicourachal Diverticulum be Prevented?

Presently, Vesicourachal Diverticulum may not be preventable, since it is a congenital condition.

• Active research is currently being performed to explore the possibilities for treatment and prevention of such conditions
• A careful and periodic monitoring of the pregnancy is advised and recommended

What is the Prognosis of Vesicourachal Diverticulum? (Outcomes/Resolutions)

• The prognosis for Vesicourachal Diverticulum in isolation is generally good with appropriate treatment
• A surgical removal of the urachal remnant in symptomatic cases can result in a cure

Additional and Relevant Useful Information for Vesicourachal Diverticulum:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/kidney-health/