Vesicourachal

Vesicourachal is a medical term used to describe relationships, structures, or anomalies involving the urinary bladder (vesica urinaria) and the urachus. The urachus is a fibrous remnant of the embryonic allantois that normally attaches the apex of the bladder to the umbilicus and obliterates before birth, becoming the median umbilical ligament. The term is commonly used in embryology, anatomy, and clinical discussions of urachal remnants.

Anatomy and development: In the embryo, the urachus forms a canal between the bladder and the umbilicus. After birth, it obliterates and forms a fibrous cord. Variations in obliteration give rise to vesicourachal anomalies, including patent urachus (urachal fistula), urachal cyst, urachal sinus, and vesicourachal diverticulum, the latter describing a bladder dome outpouching in proximity to the urachal tract.

Clinical significance: Vesicourachal remnants are often asymptomatic but can manifest with urinary or umbilical symptoms. A patent urachus may cause urine discharge from the umbilicus in infancy; cysts, diverticula, or sinuses may predispose to recurrent urinary tract infections or irritative bladder symptoms. Rarely, malignant transformation can occur in urachal remnants, most commonly urachal adenocarcinoma, typically at the bladder dome with peritoneal spread possible.

Diagnosis and management: Ultrasound is usually the first investigation; CT or MRI can delineate the tract and its relation to the bladder and umbilicus. Cystoscopy may assess bladder involvement. Treatment is conservative for incidental, asymptomatic remnants; symptomatic or suspicious lesions are typically managed by surgical excision of the urachal remnant, via open, laparoscopic, or robotic approaches, with good prognosis after complete removal.