Urachal conditions are rare, poorly understood, and often diagnosed late. Many patients struggle to find clear, reliable information online—especially about modern robotic surgery. This page explains urachal cysts, urachal carcinoma, and how robotic-assisted surgery is used to treat them in a clear and straightforward way.
What Is the Urachus, and Why Can It Cause Problems in Adults?
The urachus is a tube that connects the bladder to the umbilicus (belly button) during early fetal development.
Usually, it closes before birth and becomes a fibrous band.
Why problems occur
In some people, the urachus does not fully close, leaving behind tissue that can:
- Become infected
- Fill with fluid
- Develop abnormal cells
- Very rarely, it turns into cancer
Although urachal problems are more common in children, adults are more likely to develop serious complications, including cancer.
What Is a Urachal Cyst and How Is It Different From a Urachal Sinus?
A urachal cyst is a fluid-filled pocket within the urachus.
A urachal sinus is an open tract that usually connects to the umbilicus.
Key differences explained.
- Urachal cyst:
- Closed structure
- Can become infected
- Often causes pain, swelling, or infection
- Urachal sinus:
- Open to the belly button
- May cause discharge or recurrent infections
Why this matters
Repeated infections and long-standing inflammation increase the risk of cancerous change, especially in adults.
Can a Urachal Cyst Turn Into Cancer?
Yes, although it is uncommon.
Studies suggest that chronic inflammation of urachal remnants is a key risk factor for malignant transformation (change into cancer). This is why surgical removal is usually recommended in adults, even if symptoms are mild.
What Is Urachal Carcinoma, and How Rare Is It?
Urachal carcinoma is a rare cancer that develops from urachal tissue.
Key facts
- Accounts for less than 1% of all bladder cancers
- Most cases are adenocarcinomas (gland-forming cancers)
- Around 60–70% are mucinous adenocarcinomas, meaning they produce mucus
- Often diagnosed at a later stage because symptoms are vague
Common symptoms
- Blood in the urine
- Pain below the belly button
- Umbilical discharge
- Recurrent urinary infections
Why Is Urachal Cancer Different From Typical Bladder Cancer?
Most bladder cancers arise from the inner lining of the bladder.
Urachal cancer arises outside the bladder cavity, growing from the top (dome) of the bladder upwards towards the umbilicus.
Why this changes treatment
- The cancer spreads along the urachal tract
- Standard bladder cancer operations are not sufficient
- Complete removal of the urachus and umbilicus is essential
Incomplete surgery is linked to higher recurrence rates.
Why Is Robotic Surgery Used to Remove Urachal Disease?
Robotic-assisted surgery uses robotic arms controlled by the surgeon to perform precise operations through small incisions.
Benefits of robotic surgery explained.
- Better visualisation of deep pelvic structures
- Precise dissection of the urachal tract
- Improved control when removing part of the bladder
- Smaller incisions
- Less pain and blood loss
- Faster recovery
These advantages are significant because urachal disease lies between the bladder and the abdominal wall, a complex area to access safely.
What Does Robotic Removal of a Urachal Cyst or Cancer Involve?
The operation typically includes one or a combination of the following:
- Removal of the urachus
- Removal of the umbilicus (umbilectomy)
- Removal of a small portion of the bladder dome if involved
- In selected cases, removal of nearby lymph nodes
Robotic surgery allows this to be done en bloc, meaning everything is removed together to reduce cancer spread.
Why Is the Umbilicus (Belly Button) Removed?
This is one of the most misunderstood aspects of urachal surgery.
The reason is simple
The urachus ends at the umbilicus.
If the umbilicus is left behind:
- Cancer cells may remain
- Recurrence risk increases
Studies consistently show that failure to remove the umbilicus is associated with worse cancer outcomes.
When Is Part of the Bladder Removed?
A partial cystectomy means removing only the affected part of the bladder.
This is done when:
- The tumour involves the bladder dome
- There is a direct extension into the bladder tissue
Why this is important
- Preserves most bladder function
- Avoids removing the entire bladder
- Maintains quality of life
In published robotic series, over 90% of patientswith partial bladder removal rather than complete bladder removal.
What Are the Outcomes of Robotic Surgery for Urachal Carcinoma?
Data is limited because the disease is rare, but available studies are encouraging.
Reported outcomes
- Low complication rates
- Short hospital stays (often 2–4 days)
- Reasonable cancer control in early-stage disease
- Recurrence rates around 10–15% in published series
- Most recurrences occur within the first 2 years
Robotic outcomes are comparable to open surgery, with better recovery profiles.
Is Lymph Node Removal Always Needed?
Not always.
Lymph node removal is considered when:
- Imaging suggests lymph node involvement
- The tumour is high-grade
- There are aggressive pathological features
Approximately 70–75% of patients in reported robotic series underwent lymph node removal.
What Happens After Robotic Surgery?
Recovery
- Catheter for 7–14 days
- Gradual return to regular activity over 4–6 weeks
Follow-up
Because urachal cancer can recur:
- Regular scans are essential
- Cystoscopy may be used
- Blood tests and imaging are tailored individually
Most recurrences occur early; therefore, structured follow-up is critical.
Frequently Asked Questions (FAQ)
Is urachal cancer aggressive?
It can be, especially if diagnosed late. Early complete surgery offers the best outcomes.
Is robotic surgery better than open surgery?
Cancer control appears similar. Robotic surgery offers faster recovery and less surgical trauma.
Can urachal disease be missed on scans?
Yes. MRI and CT scans are helpful, but a diagnosis is sometimes made only after surgery.
Is chemotherapy always required?
No. Surgery is the primary treatment. Chemotherapy is considered in advanced or recurrent disease.
