Urachal Adenocarcinoma Treatment at Institute of Urology, Jaipur: Urachal adenocarcinoma is a rare malignancy, accounting for only 1% of all bladder cancers. Due to its rarity and non-specific presentation, early diagnosis is often challenging. This case report details the timely identification and successful laparoscopic en bloc resection of urachal adenocarcinoma at the Institute of Urology, Jaipur, highlighting the role of expert clinical judgment in managing rare urological malignancies.
Case Presentation
A 53-year-old male presented to the outpatient department (OPD) of the Institute of Urology, Jaipur, with complaints of mild haematuria and increased urinary frequency, both during the day and night. He had no prior medical illnesses or significant past medical history.
Given the symptoms, differential diagnoses included urinary tract infection (UTI), benign prostatic hyperplasia (BPH), bladder stones, or bladder malignancy. After ruling out common causes through initial examinations and laboratory investigations, a bladder pathology was suspected.
Diagnostic Evaluation
- Routine Blood and Urine Investigations: No significant abnormalities were detected.
- Cystoscopy and Bladder Biopsy: Revealed a suspicious lesion at the dome of the bladder.
- Histopathological Examination (HPE): Confirmed the diagnosis of mucin-secreting urachal adenocarcinoma.
- Contrast-Enhanced CT (CECT) Scan: Further supported the diagnosis and ruled out distant metastasis.
Treatment Plan
After discussing the diagnosis with the patient and his family, a surgical intervention was planned. Given the localized nature of the tumor, the team decided on a laparoscopic en bloc resection of the umbilicus, urachus, and bladder tumor, ensuring complete removal with clear margins.
Surgical Procedure
The patient underwent laparoscopic en bloc resection with minimal blood loss and excellent intraoperative stability. The tumor was completely excised with adequate surgical margins, ensuring minimal risk of recurrence.
Postoperative Outcome
- The patient tolerated the surgery well and had an uneventful recovery.
- Postoperative USG showed no fluid collection or complications in the peritoneal cavity.
- The patient was discharged with proper follow-up instructions.
- On follow-up, the patient reported significant improvement, with no further urinary complaints.
Discussion
Urachal adenocarcinoma arises from the urachal remnant, an embryological structure that normally regresses after birth. It is often diagnosed late due to vague symptoms. In this case, early suspicion and expert decision-making led to prompt diagnosis and curative surgery.
Recent studies emphasize the role of minimally invasive surgical techniques such as laparoscopic and robotic-assisted surgeries in managing urachal tumors, offering quicker recovery and reduced morbidity.
The Role of Expert Urological Care
The timely diagnosis and effective surgical management of this rare condition were made possible by the expertise of Dr. M Roychowdhury and Dr. Rajan Bansal at the Institute of Urology, Jaipur. Their clinical acumen ensured that unnecessary investigations were avoided, and the patient received targeted and efficient treatment.
At the Institute of Urology, Jaipur, patients receive comprehensive urological care under one roof, including consultations, diagnostic evaluations, imaging, laboratory tests, and surgical interventions, ensuring seamless and personalized treatment. With a patient-centric approach and state-of-the-art infrastructure, the institute continues to provide world-class urological care.
Conclusion
This case highlights the importance of clinical expertise in diagnosing rare conditions like urachal adenocarcinoma. Early suspicion, timely diagnosis, and skilled surgical intervention can significantly improve patient outcomes. Minimally invasive laparoscopic surgery remains a preferred approach for treating urachal tumors, offering patients a better prognosis and faster recovery.
