Diagnostics, Treatment of Tumors of the Urinary Duct (Clinical Observations)

Abstract

Despite low prevalence in the population, urachus tumors are of clinical interest because some of them may be malignant with a high degree of aggression. The most common malignant tumor of urachus is mucinous adenocarcinoma (MA). In the absence of reliable MA biomarkers, careful evaluation of clinical data is essential to determine the risk of its presence and radical treatment.

The objective: a comparative analysis of complaints, symptoms, instrumental / imaging data and treatment results in patients with MA and benign tumor of the urachus.

Materials and methods. We report three clinical cases of urachus tumors (2 malignant and 1 benign), which were detected among patients of the Institute of Urology of the National Academy of Medical Sciences of Ukraine for the period from 2016 to 2020.

Standard preoperative examination of patients included: collection of complaints, medical history, physical examination (including palpation of the abdomen in the umbilical and hypogastral areas), general clinical laboratory tests, ultrasound, urethrocystoscopy with TUR biopsy (2 patients), imaging (CT in 2, MRI in 1). All patients underwent surgical treatment: laparoscopic removal of urachus with resection of the bladder within the “healthy tissues”. The postoperative follow-up period lasted from 1 to 33 months.

Results. In 2 patients (man and woman) according to the results of pathohistological examination of the surgical material was detected MA, in 1 man – leiofibromyoma (LFM). MA was clinically manifested by macrohematuria – 2 (100%) and low back pain – 1 (50%). Pollakiuria and discomfort in the bladder area were observedIn case of LFM. Palpation did not allow to diagnose urachus tumor in any of the patients. On MRI scans, MA was defined as a soft tissue formation with uneven clear contours, with moderate enhancement by contrast, cystic component and calcification, located in the urachus area. On CT scans – as a heterogeneous neoplasm at the apex of the bladder with endo- and exophytic components. Instead, LFM was identified as a soft tissue formation (+34 .. +50 .. +70 units H) with predominantly endophytic growth, which accumulates contrast in the arterial and venous phases. At cystoscopy MA has the form of a papillary neoplasm in the area of the apex of the bladder on the type of “cauliflower”, while LFM has no papillary component. After laparoscopic removal of urachus with wedge-shaped resection of the bladder for a period of 1 to 33 months, cystoscopy did not reveal recurrence of tumors.

Conclusions. In the absence of reliable biomarkers, clinical characteristics remain the only “tool” that can predict the risk of MA. Compared with benign tumors of urachus, the characteristic clinical signs of MA are: macrohematuria, exophytic growth, the appearance of “cauliflower” on cystoscopy, the presence of calcifications and cysts in the structure. Even with high aggression potential of MA (low-grade tumors), laparoscopic removal of urachus with resection of the bladder within the “healthy tissues” at an early stage can provide a fairly long recurrence-free period (up to 33 months). Further research is needed to develop MA biomarkers.