Most urachal problems can be found with a physical exam and ultrasound.
Chemical Cauterization for Umbilical Granuloma
This is done in the office of your primary care provider. An umbilical granuloma is a superficial abdominal wall problem. It will heal after treatment with antibiotics. There are usually no long-term issues.
If There Is a Sinus (abnormal opening)
Unlike the simple granuloma, umbilical wetness that does not go away should be looked at by a urologist.
About 65% of all urachal problems appear as a sinus or drainage opening at the belly button. Most of those are not connected all the way to the bladder. But a few cases have an open pathway from the bladder to the belly button. This is called a patent urachus. This can be confirmed by testing urea and creatinine levels in the fluid. These levels would be high if the fluid was urine from a bladder connection.
Antibiotics for Infection
Redness can be caused by this drainage, as well as infection of the skin. If there is pain or fever, or the redness spreads to nearby skin, you will need prompt antibiotic treatment and a possible hospital stay. This type of infection of the umbilical stump is called omphalitis. It can be from bacteria from a urachal sinus. Or it could be caused by something else in the belly button area that once joined to the bowels.
Once the swelling is controlled, the opening at the belly button can be looked at with a sinogram. A small tube is placed into the sinus opening and contrast dye flows in. X-rays are then taken to look at the channel. If the channel follows the path to the top of the bladder, the diagnosis is urachal sinus.
The urachus and all of its connections (plus a small amount of the top of the bladder) should be fully removed with surgery. Leaving any tissue behind could allow cancer to develop. Less than 1% of all bladder cancer occurs in the urachus. But once the urachus has potentially become a problem, it should be removed.
If There Is No Sinus
When there is no draining sinus to look into, ultrasound of the lower belly will often show a fluid-filled, enclosed lump in the location of the urachus. In an adult with a small chance of cancer, abdominal and pelvic CT scans may also be helpful.
Antibiotics for Infected Cysts
About 80% of infected cysts contain Staphylococcus aureus and many other types of bacteria. An infected cyst almost always stays in the same place. Rarely, an infected cyst will drain into the space between the stomach and other organs, causing inflammation and fever. Antibiotics will heal the infection.
Again, complete removal of the urachus is important. After simple drainage with a needle, urachal abnormalities come back in about a third of patients. This is because the linings and structures are still present.
Sometimes a voiding cystourethrogram (an x-ray using contrast dye) is useful even after a physical exam and ultrasound. This is done when the draining urachus is linked to bladder outlet obstruction, which would also need to be treated. This is most often settled by the patient’s age, gender and physical exam.
In some cases a direct look into the bladder with a cystoscopy can be helpful. But most urologists suggest using the methods previously mentioned.