Also a trochar technique with peel away rather than Seldinger
Urachal anomalies
- Patent urachus: Entire urachal channel fails to close
- Urachal cyst: Umbilical and bladder openings close; channel between remains open and fluid or mucin filled
- Umbilical-urachal sinus: Patency of urachus at umbilical end; no communication with bladder
- Urachal diverticulum: Patency of urachus at bladder end; no communication with umbilicus
- Vestigial obliterated urachus = median umbilical ligament
- Obliterated umbilical arteries = medial umbilical ligaments = adjacent paired band
The vestigial obliterated urachus forms the median umbilical ligament. Obliterated umbilical arteries form the paired medial umbilical ligaments
Clinical issues
- Infection, pain, recurrent UTI, discharge
- Diverticulum - recurrent UTI and stone formation from stasus
- Patent - leakage from umbilicus
- Urachal carcinoma - **adenocarcinoma
- Primary bladder adenoCA is rare
Ddx
- Vitelline cyst: Failure in complete obliteration of omphalomesenteric duct
Space of Retzius
- AKA retropubic space AKA prevesical space
- Avascular portion of the extraperitoneal compartment w/ loose connective and adipose tissues
- Contains the median umbilical ligament
- Boundaries
- Anterior transversalis, anterior abd wall, and pubic symphisis
- Posteriorly the bladder
- Laterally the pubic bones and fascia of obturator internus mm
- Inferior the puboprostatic ligaments or pubovesical ligaments and superior fascia of the levator ani muscle
- Superior extends to the level of the umbilicus
- Named for Anders Retzius (Swedish prof of anatomy in late 18 thru 19th century)
- Important for identifying extraperitoneal bladder rupture (most common 80-90% of cases) and usually d/t pelvic fx or penetrating trauma
- Contrast confined to space of Retzius forms the molar tooth sign outlining the space (in a simple extraperitoneal rupture)