Gross Hematuria and Calcification as Independent Predictors of Urachal Carcinoma in Adults: A Single-Center Retrospective Analysis

Gross Hematuria and Calcification as Independent Predictors of Urachal Carcinoma in Adults: A Single-Center Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gross Hematuria and Calcification as Independent Predictors of Urachal Carcinoma in Adults: A Single-Center Retrospective Analysis Kinh Luan Thai, Phan Nhat Duy Le, Thanh Tuan Nguyen, Xuan Thai Ngo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8300930/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Urachal anomalies are rare entities in the adult population with significant malignant potential. This study aims to comprehensively describe clinical and paraclinical characteristics, as well as to analyze and evaluate prognostic factors for urachal carcinoma, thereby facilitating early diagnosis and effective management . Methods: We conducted a retrospective, cross-sectional study on patients diagnosed with urachal anomalies from 2017 to 2025. Data regarding clinical characteristics, imaging findings, treatment modalities, and clinical outcomes were collected for both benign and malignant cases. Additionally, survival outcomes were specifically analyzed for patients with urachal carcinoma. Results: A total of 112 patients were included, comprising 8.9% cases of urachal carcinoma, while infection was the predominant presentation (72.3%). Surgical management differed significantly by pathology, with urachal excision and partial cystectomy performed in 80.0% of malignant cases versus 23.9% of benign cases. Multivariate logistic regression identified hematuria (OR 14.1; 95% CI 1.3–153.6; p=0.03) and calcification (OR 13.5; 95% CI 1.7–109.2; p=0.01) as significant independent predictors of malignancy. Histologically, adenocarcinoma was the major subtype (80%), with most tumors being Sheldon stage IIIA or IV. Overall survival (OS) showed a steep decline, recorded at 90.0%, 60.0%, and 15.0% at 1, 3, and 5 years, respectively. Conclusions: Gross hematuria and calcification serve as critical, independent predictors of urachal malignancy. Given the aggressive nature and poor overall prognosis (5-year OS of only 15.0%), the presence of these indicators necessitates an aggressive diagnostic workup 33 and prompt radical surgical intervention (en-bloc urachal excision with partial cystectomy) to optimize long-term patient outcomes. urachal anomalies urachal carcinoma urachal neoplasm prognostic factor Figures Figure 1 Figure 2 Introduction The urachus, a vestigial embryological remnant connecting the bladder dome to the umbilicus, is typically obliterated after birth. However, failure of this regression leads to a spectrum of anomalies ranging from benign cysts to patent urachus. While historically considered rare congenital defects, these anomalies have gained clinical prominence due to their diverse presentations and more critically, their potential for malignant degeneration [ 1 , 2 ]. The clinical landscape of urachal disease is characterized by deceptive duality. On one hand, benign complications such as infection are common and manageable. On the other hand, urachal carcinoma (UrC) accounting for less than 1% of bladder malignancies is an exceptionally aggressive entity [ 3 ]. Arising from non urothelial origins, UrC often grows silently in the extraperitoneal space, presenting only at advanced stages with poor survival outcomes. Crucially, distinguishing between a superimposed infection and an aggressive carcinoma remains a formidable diagnostic challenge. Preoperative imaging often fails to differentiate inflammatory distinct masses from malignancy due to overlapping radiological features. This uncertainty complicates surgical decision-making: distinguishing cases that require simple excision from those mandating radical partial cystectomy is often difficult [ 4 ]. Currently, there is a paucity of data identifying specific preoperative predictors to guide this stratification, particularly in the Vietnamese population. Therefore, this study was conducted to comprehensively delineate the clinicopathological characteristics of urachal anomalies and, most importantly, to identify independent prognostic factors such as hematuria and calcification that can assist clinicians in early diagnosis, surgical planning, and improving oncological outcomes. Methods Study Design and Population This retrospective study was conducted at Cho Ray Hospital, a tertiary referral center, enrolling all consecutive patients diagnosed and treated for urachal anomalies between January 2017 and May 2025. Patients were identified based on clinical presentation and confirmatory imaging (ultrasound, computed tomography). The exclusion criteria comprised patients with incomplete medical records, those with non-urachal pathologies involving the bladder dome, or patients lost to follow up. A total of 112 patients met the inclusion criteria, comprising 102 benign cases and 10 cases of urachal carcinoma. Data were retrieved from electronic medical records, including patient demographics, presenting symptoms, and imaging characteristics. For malignant cases, pathological staging was strictly classified according to the Sheldon system and the Mayo (modified TNM) system. Staging was determined through a comprehensive review of surgical records and final histopathological reports. Surgical details, perioperative complications, and pathological outcomes were recorded. Follow-up data regarding recurrence and survival were obtained through clinical visits or telephone interviews. Surgical Technique: for all patients diagnosed with or suspected of having urachal carcinoma, the goal was radical en-bloc resection. This was specifically defined as urachal excision with partial cystectomy (PC), which included the resection of the urachal remnant, the umbilicus (where applicable, though it was not performed in our series ), and a cuff of the dome of the bladder (including a minimum 2 cm margin around the tumor base). Simple urachal excision was reserved only for benign or localized infectious processes. Imaging assessment: imaging features were reviewed by two independent radiologists. Calcification was specifically recorded as a positive feature if it presented as stippled or central calcifications within the mass, which are highly suggestive of mucin-producing adenocarcinomas. This was distinct from simple peripheral or "egg-shell" calcification often associated with chronic benign cysts. Irregular borders were defined as non-smooth, ill-defined margins indicating perivesical infiltration. Continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using Fisher’s exact test. To identify independent predictors of malignancy, univariate and multivariate logistic regression analyses were performed. Given the low prevalence of urachal carcinoma (n = 10) and the potential for small-sample bias (quasi-complete separation), we utilized Firth’s penalized logistic regression. Variables demonstrating statistical significance (p < 0.05) in the univariate analysis were considered candidates for the multivariate model. However, to ensure model stability and prevent overfitting due to the limited number of events, only the three most clinically and statistically significant variables were selected for inclusion in the final multivariate analysis. Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range [IQR]) and compared using the student’s t-test or Mann-Whitney U test. Categorical variables were presented as frequencies and percentages, compared using the Chi-square test or Fisher’s exact test. Survival outcomes for the malignant cohort were estimated using the Kaplan–Meier method. All statistical tests were two-sided, with a p-value < 0.05 considered statistically significant. Analyses were conducted using Stata and R. Results Baseline Characteristics and Comparison between Groups The comparison of demographic and clinical characteristics between the benign (n=102) and malignant (n=10) groups is summarized in Table 1. Patients with urachal carcinoma were significantly older than those with benign anomalies (median age 56 vs. 39 years, p = 0.005). While males accounted for 70% of the malignant cohort compared to 50% of the benign cohort, this difference did not reach statistical significance (p = 0.324). Regarding clinical presentation, gross hematuria was a distinguishing feature of malignancy, observed in 50.0% of cancer patients versus only 2.0% of benign cases (p = 0.001). Conversely, symptoms typical of inflammation, such as umbilical discharge, were predominantly found in the benign group. Radiologically, malignant tumors were significantly larger (median 4.0 cm vs. 2.25 cm) and frequently exhibited suspicious features. Notably, calcification (50.0% vs. 2.9%, p < 0.001) and irregular tumor borders (100% vs. 16.7%, p < 0.001) were strongly associated with carcinoma. [insert table 1 here] To identify independent predictors of malignancy, univariate and multivariate analyses were performed. Given the low prevalence of carcinoma (n=10) and the presence of perfect separation in variables such as irregular borders, Firth’s penalized likelihood logistic regression was utilized to mitigate small-sample bias. In the univariate analysis, lower urinary tract symptoms, gross hematuria, calcification, irregular borders, and anterior/dome tumor location were significantly associated with malignancy (p < 0.05). To ensure model stability given the limited number of events, only the most clinically relevant variables were entered into the final multivariable model (Table 2). The analysis identified gross hematuria (OR 14.1; 95% CI 1.3–153.6; p=0.03) and calcification (OR 13.5; 95% CI 1.7–109.2; p=0.01) as significant independent risk factors for urachal carcinoma (Fig. 1). [insert table 2 here] [insert Figure 1 here] Detailed characteristics of the 10 malignant cases are presented in Table 3. The mean age was 54.5 ± 10.2 years. Preoperative diagnosis proved challenging; urachal carcinoma was correctly suspected in only 50% of cases. The remaining cases were initially misdiagnosed as bladder tumors (n = 4) or an infected urachal cyst (n = 1) and were only confirmed upon final histology. Pathological evaluation revealed that adenocarcinoma was the predominant subtype (80%), followed by squamous cell carcinoma (10%) and small-cell neuroendocrine carcinoma (10%). The majority of patients presented with locally advanced disease, with 90% (9/10) staged as pT3. According to the Sheldon staging system, 70% were classified as stage IIIA, while 30% presented with metastasis (Stage IVB). Regarding management, en-bloc urachal excision with partial cystectomy was the standard surgical approach, performed in 80% (8/10) of cases. Adjuvant chemotherapy was administered to 80% (8/10) of patients, reflecting a consistent multimodal strategy. Platinum-based regimens were the standard of care, with Gemcitabine–Cisplatin being the most frequently utilized combination (50%), followed by Gemcitabine–Carboplatin. Notably, one patient with small-cell neuroendocrine carcinoma was treated with Etoposide–Cisplatin. Survival outcomes were analyzed for the malignant cohort (Fig. 2). The 1-, 3-, and 5-year OS rates were 90.0%, 60.0%, and 15.0%, respectively. The survival curve showed a steep decline between 12 and 36 months. Prognosis was strictly stratified by metastatic status: patients with non-metastatic disease (M0, n=8) achieved a median OS of 46 months, whereas those presenting with distant metastasis (M1, n=2) had a significantly poorer median OS of only 3 months (log-rank p = 0.034). [insert Figure 2 here] [insert table 3 here] Discussion The management of urachal anomalies in adults presents a distinct set of diagnostic and therapeutic challenges. In our cohort of 112 patients, the malignancy rate was 8.9%. This figure is notably lower than the 30–60% reported in specialized cancer centers [ 1 ], likely reflecting a more generalized prevalence in a tertiary setting that captures a broader spectrum of symptomatic benign cases. Our study confirmed that infection remains the predominant complication (72.3%), reinforcing the clinical paradigm that urachal remnants often remain quiescent until a secondary inflammatory event prompts medical attention. Differentiating between infected urachal cysts and carcinomas remains a formidable challenge due to overlapping radiological features. A pivotal finding of our study is the identification of gross hematuria and calcification as robust independent predictors of malignancy. Our multivariate analysis using Firth’s penalized regression revealed that patients presenting with gross hematuria had a 14-fold increased risk of carcinoma. This aligns with findings by Ashley and Bi reflecting the tumor's invasion through the bladder wall and mucosal ulceration a feature rarely seen in benign infections which typically drain via the umbilicus [ 1 , 5 ]. Crucially, calcification emerged as a strong predictor. While peripheral "egg-shell" calcification can occur in chronic cysts, the presence of stippled or central calcifications on CT scans is highly suggestive of mucin-producing adenocarcinomas [ 6 ]. These findings advocate for the mandatory use of CT/MRI in adults presenting with these risk factors to guide surgical planning, specifically the decision to perform a partial cystectomy. Radical surgical resection remains the cornerstone of curative therapy. In our series, open surgery was performed in 73.9% of cases, a rate higher than contemporary laparoscopic series. This reflects the complexity of our cohort, characterized by large inflammatory masses, abscess formation, and locally advanced malignancies requiring extensive safety margins. Regarding the extent of resection, en-bloc partial cystectomy was performed in 80% of malignant cases. We strongly advocate for this aggressive approach not only for confirmed malignancies but also for indeterminate masses adherent to the bladder dome, as microscopic urachal remnants have been found within the bladder muscularis in up to 73% of cases, posing a significant risk for recurrence if a simple excision is performed [ 7 ]. The prognosis of urachal carcinoma in our cohort was poor, with a 5-year OS of only 15%. This is significantly lower than 50% reported in Western series [ 2 , 8 ]. Several factors contribute to this disparity as late-stage presentation was predominant, with 90% of our patients diagnosed at stage pT3 or higher (Sheldon IIIA/IVB). This reflects the silent natural history of the disease in our population. Second, regarding adjuvant therapy, while 80% of our patients received platinum-based chemotherapy, the regimens varied (Gemcitabine-Cisplatin, FOLFOX, etc.) and some did not strictly adhere to current NCCN guidelines (5-FU/Platinum combinations, ITP) [ 9 ]. The lack of standardized protocols and the aggressive biology of the tumors likely contributed to the suboptimal outcomes. This underscores the urgent need for centralized multidisciplinary management and adherence to evidence-based chemotherapy protocols to improve survival. Pelvic LND was performed in only 10% of our cases, primarily due to the lack of preoperative suspicion of malignancy in many patients. While the therapeutic benefit of LND remains debated, its prognostic value is indisputable. Given that nodal involvement is a critical determinant of survival, we now advocate for a more standardized approach to LND in all cases of suspected urachal carcinoma to ensure accurate staging. Staging of urachal carcinoma remains a subject of debate. The Sheldon classification and modified TNM systems are most widely applied, although neither has been universally adopted [ 10 ]. In our cohort, 70% of patients were classified as Sheldon stage IIIA and 30% as stage IVB, indicating a predominance of locally advanced and metastatic disease. This distribution closely mirrors prior studies showing that more than half of patients are present with stage III or IV disease. When mapped to TNM categories, 90% of our tumors were T3, with one patient exhibiting nodal metastasis and two presenting distant metastases (bone, peritoneum, and lymph nodes). These findings again reflect the silent natural history of UrC, where symptoms arise only after the tumor breaches the bladder dome or adjacent peritoneum. Radical surgical resection remains the cornerstone of curative therapy for urachal carcinoma. The standard approach is partial cystectomy with en bloc removal of the urachus, umbilicus, and surrounding perivesical and peritoneal tissue, ensuring negative surgical margins [ 3 , 10 ]. In our series, eight patients (80%) underwent urachal excision combined with partial cystectomy, while one patient underwent urachal excision alone and one underwent partial cystectomy alone. Open and laparoscopic approaches were used equally (five each), demonstrating that minimally invasive surgery is feasible in selected cases. None of our patients underwent concomitant umbilical excision, which diverges from many protocols advocating routine umbilectomy. Several large series have reported that including the umbilicus in the resection specimen improves local control and OS, suggesting that this step should be considered standard when technically feasible. Pelvic lymph-node dissection (PLND) was performed in only one patient. While PLND has limited therapeutic benefit, it plays an important staging and prognostic role [ 11 ]. Previous studies have shown that regional nodal involvement correlates with a markedly reduced survival comparable to that of distant metastasis. Therefore, standardized nodal assessment should be encouraged to better define disease burden and guide adjuvant therapy [ 12 ]. Our study is subject to limitations inherent to its retrospective, single-center design. The small cohort of urachal carcinoma (n = 10) inherently restricts statistical power; however, we mitigated this potential bias by employing Firth’s penalized likelihood regression, ensuring the robustness of the identified prognostic factors despite the limited number of events. Additionally, as a tertiary referral center, selection bias likely favors complex, locally advanced cases, which may explain the higher prevalence of open surgery and late-stage presentation compared to general populations. Finally, the heterogeneity of adjuvant chemotherapy regimens and the low rate of lymph node dissection limit our ability to draw definitive conclusions regarding the optimal multimodal management strategies. Despite these constraints, this study provides critical, previously unavailable data on the clinical profile and prognostic markers of urachal anomalies in the Vietnamese population. Conclusion Despite these limitations, this study provides valuable data on the distinct clinical profile of urachal anomalies in the Vietnamese population. The identification of hematuria and calcification as key predictors should prompt aggressive diagnostic workup and radical surgery, potentially improving early detection and survival outcomes in this lethal disease. Abbreviations UrC: Urachal carcinoma PC: Partial cystectomy TNM: Tumor, Node, Metastasis CT: Computed tomography MRI: Magnetic resonance imaging SD: Standard deviation IQR: Interquartile range OR: Odds Ratio CI: Confidence Interval OS: Overall survival M0/M1: Metastasis (No/Yes) LND: Lymph-node dissection PLND: Pelvic lymph-node dissection IRB: Institutional Review Board NCCN: National Comprehensive Cancer Network Declarations Ethics approval and consent to participate This research was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City, (IRB-VN01002/IRB00010293/FWA00023448) with Approval No. 51/HĐĐĐ-ĐHYD, dated January 2, 2025. The Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City waived the need for individual informed consent as this was a retrospective study using anonymized data. Consent for publication Not applicable. Clinical Trial: Not applicable (retrospective study). Availability of data and materials De-identified clinical dataset and analysis code that support the findings are available from the corresponding author upon reasonable request, subject to institutional and national data-protection regulations. Competing interests The authors declare that they have no competing interests. Funding Not applicable. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Study design: Kinh Luan Thai Acquisition of data: Phan Nhat Duy Le, Thanh Tuan Nguyen Drafting of manuscript: Duy Le Phan Nhat Critical revision of the manuscript: Kinh Luan Thai, Xuan Thai Ngo Acknowledgements Not applicable. Authors' information (optional) Not applicable. References Ashley RA, Inman BA, Routh JC, et al. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. The Journal of urology. 2007;178(4 Pt 2):1615-8. Bruins HM, Visser O, Ploeg M, et al. The clinical epidemiology of urachal carcinoma: results of a large, population based study. The Journal of urology. 2012;188(4):1102-7. Szarvas T, Módos O, Niedworok C, et al. Clinical, prognostic, and therapeutic aspects of urachal carcinoma-A comprehensive review with meta-analysis of 1,010 cases. Urologic oncology. 2016;34(9):388-98. Ke C, Hu Z, Yang C. Preoperative accuracy of diagnostic evaluation of urachal carcinoma. Cancer medicine. 2023;12(8):9106-9115. Bi X, Wu Z, Han H, et al. Clinical comparison of patients with benign urachal masses versus urachal carcinomas. Chin J Cancer. 2017;36(1):2. Das JP, Vargas HA, Lee A, et al. The urachus revisited: multimodal imaging of benign & malignant urachal pathology. The British journal of radiology. 2020;93(1110):20190118. Hoshi A, Chihara I, Shiga M, et al. Laparoendoscopic single-site surgery for urachal remnant with extraperitoneal approach through a suprapubic port. Asian J Endosc Surg. 2022;15(3):569-576. Mylonas KS, P OM, Ziogas IA, et al. Malignant urachal neoplasms: A population-based study and systematic review of literature. Urologic oncology. 2017;35(1):33 e11-33 e19. Flaig TW, Spiess PE, Abern M, et al. NCCN Guidelines® Insights: Bladder Cancer, Version 3.2024. J Natl Compr Canc Netw. 2024;22(4):216-225. Limonnik V, Samiei A, Abel S, et al. Urachal carcinoma: A novel staging system utilizing the National Cancer Database. Cancer medicine. 2023;12(3):2752-2760. Hamilou Z, North S, Canil C, et al. Management of urachal cancer: A consensus statement by the Canadian Urological Association and Genitourinary Medical Oncologists of Canada. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020;14(3):E57-e64. Loizzo D, Pandolfo SD, Crocerossa F, et al. Current Management of Urachal Carcinoma: An Evidence-based Guide for Clinical Practice. European urology open science. 2022;39:1-6. Tables Table 1: Clinicopathological characteristics of benign versus malignant urachal anomalies Parameter Urachal anomalies n (%) Urachal cancer n (%) p-value Age (years) (IQR) 39 (30 – 51) 56 (45 - 60) 0.005 Gender Male 53 (51.96) 7 0.324 Female 49 (48.04) 3 Symptoms Gross hematuria 2 (1.96) 5 (50) 0.001 Low abdominal pain 47 (45.08) 2 (20) 0.367 Umbilical discharge 61 (59.80) 1 (10) 0.041 Lower urinary symptoms 12 (11.76) 3 (30) 0.187 Fever 7 (6.86) 0 1.000 Umbilical mass 33 (32.35) 1 (10) 0.721 Asymptomatic 7 (6.86) 1 (10) 0.539 Imaging Features Median tumor size (cm) (IQR) 2.25 (1.45 - 3.55) 4 (3 – 5) 0.018 Calcification 3 (2.94) 5 (50) <0.001 Irregular borders 17 (16.67) 10 (100) <0.001 Tumor location: Anterior/ dome bladder wall 18 (17.65) 7 (70) 0.001 Medical therapy (n = 10) 10 (9.80) 0 Surgery (n =102) 92 (90.20) 10 (100) Approach Open surgery 68 6 Laparoscopic surgery 23 4 Robot-assisted laparoscopic surgery 1 0 Surgical technique Urachal excision 70 1 Partial cystectomy 0 1 Urachal excision with PC 22 8 Umbilectomy performed 18 0 IQR: interquartile range, PC: Partial cystectomy Table 2 : Univariable logistic regression analysis of predictors for urachal. Parameter OR (95% Cl) p-value Age > 55 3.3 (0.9 – 12.3) 0.078 Lower urinary tract symptoms 5.0 (1.2 – 20.9) 0.026 Gross hematuria 16.7 (3.4 – 82.8) <0.001 Low abdominal pain 0.3 (0.1 – 5.6) 0.419 Calcification 16.7 (3.4 – 82.8) <0.001 Irregular borders 57.9 (3.2 – 1044.5) 0.006 Anterior/dome bladder wall 5.0 (1.3 – 20.0) 0.021 CI: confidence interval; OR: odds ratio. Table 3. Clinicopathological characteristics, staging, and treatment of urachal carcinoma Case Sex Age Tumour location Size (cm) Preoperative diagnosis Procedure Approach PLND Umbilectomy Histopathology TNM Sheldon Chemothapary No. of cycles 1 F 73 Urachus 3.0 Infected urachal cyst Urachal excision Open No No Adenocarcinoma T1N0M1 (peritoneum) IVB NA NA 2 M 60 Bladder dome 6.0 Urachal carcinoma Urachal excision with PC Lap No No Adenocarcinoma T3N0M0 IIIA Gemcitabine + Cisplatin 6 3 M 57 Bladder dome NA Bladder tumour Urachal excision with PC Lap No No Adenocarcinoma T3N0M0 IVB Gemcitabine + Cisplatin 4 4 M 55 Anterior bladder wall 4.0 Urachal carcinoma Urachal excision with PC Open No No Adenocarcinoma T3N0M0 IIIA Gemcitabine + Carboplatin 5 5 F 38 Bladder dome 5.0 Urachal carcinoma, ycT3N2M1 Urachal excision with PC Open Yes No Adenocarcinoma T3N2M1 (bone and nodal metastases) IVB Leucovorin + 5‑FU + Oxaliplatin 4 6 M 58 Urachus 2.5 Bladder tumour Urachal excision with PC Lap No No Adenocarcinoma T3N0M0 IIIA NA NA 7 M 52 Bladder dome 7.0 Urachal carcinoma Urachal excision with PC Open No No Squamous cell carcinoma T3N0M0 IIIA Gemcitabine + Carboplatin 3 8 F 44 Anterior bladder wall 2.2 Urachal carcinoma Urachal excision with PC Open No No Adenocarcinoma T3N0M0 IIIA Gemcitabine + Cisplatin 3 9 M 63 Bladder dome 3.4 Bladder tumour PC Open No No Adenocarcinoma T3N0M0 IIIA Gemcitabine + Cisplatin 3 10 F 45 Bladder dome 4.3 Bladder tumour Urachal excision with PC Lap No No Small-cell neuroendocrine carcinoma T3N0M0 IIIA Etoposide + Cisplatin 6 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8300930","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587729436,"identity":"855bc995-a876-4fd5-b9a7-85b8ebe189d8","order_by":0,"name":"Kinh Luan Thai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDACCQaGgw0GDAl8IM4HiJgBXh08MC1sQA7jDGK1MDYwQLQw8xCjxV66+eHBGQV38tgkkp89tm3blsfA3rxNgrHtDm5bZI4ZHNxg8KyYTSLN3Di37XYxA8+xMqCWZ3gclmBw8IHB4cQ2iQQzaaCWxAaJHDMJhjOH8WhJ/wDVkv5N2hKkRf4NIS05IIeBtOSYSTOCbeEBaqnAo+VGTsHBGSAtPG/KJHvO3S5m40krtkjAo4V9Rvrmjz1/Dif2s6dvk/hRdjuPn/3wxhsfDHBrwQDgCGJIIF4DiYpHwSgYBaNgZAAATItW2x98yhkAAAAASUVORK5CYII=","orcid":"","institution":"University of Medicine and Pharmacy at Ho Chi Minh City","correspondingAuthor":true,"prefix":"","firstName":"Kinh","middleName":"Luan","lastName":"Thai","suffix":""},{"id":587729437,"identity":"dd38e188-7762-489d-abdd-6ec8335a776e","order_by":1,"name":"Phan Nhat Duy Le","email":"","orcid":"","institution":"University of Medicine and Pharmacy at Ho Chi Minh City","correspondingAuthor":false,"prefix":"","firstName":"Phan","middleName":"Nhat Duy","lastName":"Le","suffix":""},{"id":587729438,"identity":"da640c11-ec78-4e02-bc1b-1d56d6d430d3","order_by":2,"name":"Thanh Tuan Nguyen","email":"","orcid":"","institution":"University of Medicine and Pharmacy at Ho Chi Minh City","correspondingAuthor":false,"prefix":"","firstName":"Thanh","middleName":"Tuan","lastName":"Nguyen","suffix":""},{"id":587729439,"identity":"ad027a66-f040-4731-80a7-6c47e0a10a9e","order_by":3,"name":"Xuan Thai Ngo","email":"","orcid":"","institution":"University of Medicine and Pharmacy at Ho Chi Minh City","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"Thai","lastName":"Ngo","suffix":""}],"badges":[],"createdAt":"2025-12-07 16:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8300930/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8300930/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102260820,"identity":"c47de64a-3b24-4b0b-a4c7-0f8a26446dca","added_by":"auto","created_at":"2026-02-10 00:34:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45333,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariate logistic regression analysis identifying independent predictors of urachal carcinoma.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8300930/v1/9f349705e12679a8eda5824f.png"},{"id":102260821,"identity":"3f96bec7-b2f0-47a8-93e5-393a6d02f56b","added_by":"auto","created_at":"2026-02-10 00:34:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45916,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier overall survival curves in patients with urachal carcinoma.\u003c/p\u003e\n\u003cp\u003e(A) Overall survival for all urachal carcinoma patients. (B) Overall survival stratified by metastatic status (M0 vs. M1). Patients with distant metastasis (M1) had significantly poor overall survival (p = 0.034).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8300930/v1/978a37b509e769cc90cdb9e4.png"},{"id":102298632,"identity":"ed411872-f5f4-48d5-8317-e324ce2b042e","added_by":"auto","created_at":"2026-02-10 10:54:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":605426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8300930/v1/4b9a9e21-386f-4871-b1fc-1dd92580badb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gross Hematuria and Calcification as Independent Predictors of Urachal Carcinoma in Adults: A Single-Center Retrospective Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe urachus, a vestigial embryological remnant connecting the bladder dome to the umbilicus, is typically obliterated after birth. However, failure of this regression leads to a spectrum of anomalies ranging from benign cysts to patent urachus. While historically considered rare congenital defects, these anomalies have gained clinical prominence due to their diverse presentations and more critically, their potential for malignant degeneration [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical landscape of urachal disease is characterized by deceptive duality. On one hand, benign complications such as infection are common and manageable. On the other hand, urachal carcinoma (UrC) accounting for less than 1% of bladder malignancies is an exceptionally aggressive entity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Arising from non urothelial origins, UrC often grows silently in the extraperitoneal space, presenting only at advanced stages with poor survival outcomes.\u003c/p\u003e \u003cp\u003eCrucially, distinguishing between a superimposed infection and an aggressive carcinoma remains a formidable diagnostic challenge. Preoperative imaging often fails to differentiate inflammatory distinct masses from malignancy due to overlapping radiological features. This uncertainty complicates surgical decision-making: distinguishing cases that require simple excision from those mandating radical partial cystectomy is often difficult [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Currently, there is a paucity of data identifying specific preoperative predictors to guide this stratification, particularly in the Vietnamese population.\u003c/p\u003e \u003cp\u003eTherefore, this study was conducted to comprehensively delineate the clinicopathological characteristics of urachal anomalies and, most importantly, to identify independent prognostic factors such as hematuria and calcification that can assist clinicians in early diagnosis, surgical planning, and improving oncological outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Population This retrospective study was conducted at Cho Ray Hospital, a tertiary referral center, enrolling all consecutive patients diagnosed and treated for urachal anomalies between January 2017 and May 2025. Patients were identified based on clinical presentation and confirmatory imaging (ultrasound, computed tomography). The exclusion criteria comprised patients with incomplete medical records, those with non-urachal pathologies involving the bladder dome, or patients lost to follow up. A total of 112 patients met the inclusion criteria, comprising 102 benign cases and 10 cases of urachal carcinoma.\u003c/p\u003e \u003cp\u003eData were retrieved from electronic medical records, including patient demographics, presenting symptoms, and imaging characteristics. For malignant cases, pathological staging was strictly classified according to the Sheldon system and the Mayo (modified TNM) system. Staging was determined through a comprehensive review of surgical records and final histopathological reports. Surgical details, perioperative complications, and pathological outcomes were recorded. Follow-up data regarding recurrence and survival were obtained through clinical visits or telephone interviews.\u003c/p\u003e \u003cp\u003eSurgical Technique: for all patients diagnosed with or suspected of having urachal carcinoma, the goal was radical en-bloc resection. This was specifically defined as urachal excision with partial cystectomy (PC), which included the resection of the urachal remnant, the umbilicus (where applicable, though it was not performed in our series ), and a cuff of the dome of the bladder (including a minimum 2 cm margin around the tumor base). Simple urachal excision was reserved only for benign or localized infectious processes.\u003c/p\u003e \u003cp\u003eImaging assessment: imaging features were reviewed by two independent radiologists. Calcification was specifically recorded as a positive feature if it presented as stippled or central calcifications within the mass, which are highly suggestive of mucin-producing adenocarcinomas. This was distinct from simple peripheral or \"egg-shell\" calcification often associated with chronic benign cysts. Irregular borders were defined as non-smooth, ill-defined margins indicating perivesical infiltration.\u003c/p\u003e \u003cp\u003eContinuous variables were compared using the Mann-Whitney U test, categorical variables were compared using Fisher\u0026rsquo;s exact test. To identify independent predictors of malignancy, univariate and multivariate logistic regression analyses were performed. Given the low prevalence of urachal carcinoma (n\u0026thinsp;=\u0026thinsp;10) and the potential for small-sample bias (quasi-complete separation), we utilized Firth\u0026rsquo;s penalized logistic regression. Variables demonstrating statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the univariate analysis were considered candidates for the multivariate model. However, to ensure model stability and prevent overfitting due to the limited number of events, only the three most clinically and statistically significant variables were selected for inclusion in the final multivariate analysis.\u003c/p\u003e \u003cp\u003eStatistical Analysis Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (interquartile range [IQR]) and compared using the student\u0026rsquo;s t-test or Mann-Whitney U test. Categorical variables were presented as frequencies and percentages, compared using the Chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003eSurvival outcomes for the malignant cohort were estimated using the Kaplan\u0026ndash;Meier method. All statistical tests were two-sided, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant. Analyses were conducted using Stata and R.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline Characteristics and Comparison between Groups The comparison of demographic and clinical characteristics between the benign (n=102) and malignant (n=10) groups is summarized in Table 1. Patients with urachal carcinoma were significantly older than those with benign anomalies (median age 56 vs. 39 years, p = 0.005). While males accounted for 70% of the malignant cohort compared to 50% of the benign cohort, this difference did not reach statistical significance (p = 0.324).\u003c/p\u003e\n\u003cp\u003eRegarding clinical presentation, gross hematuria was a distinguishing feature of malignancy, observed in 50.0% of cancer patients versus only 2.0% of benign cases (p = 0.001). Conversely, symptoms typical of inflammation, such as umbilical discharge, were predominantly found in the benign group. Radiologically, malignant tumors were significantly larger (median 4.0 cm vs. 2.25 cm) and frequently exhibited suspicious features. Notably, calcification (50.0% vs. 2.9%, p \u0026lt; 0.001) and irregular tumor borders (100% vs. 16.7%, p \u0026lt; 0.001) were strongly associated with carcinoma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[insert table 1 here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo identify independent predictors of malignancy, univariate and multivariate analyses were performed. Given the low prevalence of carcinoma (n=10) and the presence of perfect separation in variables such as irregular borders, Firth\u0026rsquo;s penalized likelihood logistic regression was utilized to mitigate small-sample bias. In the univariate analysis, lower urinary tract symptoms, gross hematuria, calcification, irregular borders, and anterior/dome tumor location were significantly associated with malignancy (p \u0026lt; 0.05). To ensure model stability given the limited number of events, only the most clinically relevant variables were entered into the final multivariable model (Table 2). The analysis identified gross hematuria (OR 14.1; 95% CI 1.3\u0026ndash;153.6; p=0.03) and calcification (OR 13.5; 95% CI 1.7\u0026ndash;109.2; p=0.01) as significant independent risk factors for urachal carcinoma (Fig. 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[insert table 2 here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[insert Figure 1 here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetailed characteristics of the 10 malignant cases are presented in Table 3. The mean age was 54.5 \u0026plusmn; 10.2 years. Preoperative diagnosis proved challenging; urachal carcinoma was correctly suspected in only 50% of cases. The remaining cases were initially misdiagnosed as bladder tumors (n = 4) or an infected urachal cyst (n = 1) and were only confirmed upon final histology. Pathological evaluation revealed that adenocarcinoma was the predominant subtype (80%), followed by squamous cell carcinoma (10%) and small-cell neuroendocrine carcinoma (10%). The majority of patients presented with locally advanced disease, with 90% (9/10) staged as pT3. According to the Sheldon staging system, 70% were classified as stage IIIA, while 30% presented with metastasis (Stage IVB).\u003c/p\u003e\n\u003cp\u003eRegarding management, en-bloc urachal excision with partial cystectomy was the standard surgical approach, performed in 80% (8/10) of cases. Adjuvant chemotherapy was administered to 80% (8/10) of patients, reflecting a consistent multimodal strategy. Platinum-based regimens were the standard of care, with Gemcitabine\u0026ndash;Cisplatin being the most frequently utilized combination (50%), followed by Gemcitabine\u0026ndash;Carboplatin. Notably, one patient with small-cell neuroendocrine carcinoma was treated with Etoposide\u0026ndash;Cisplatin.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurvival outcomes were analyzed for the malignant cohort (Fig. 2). The 1-, 3-, and 5-year OS rates were 90.0%, 60.0%, and 15.0%, respectively. The survival curve showed a steep decline between 12 and 36 months. Prognosis was strictly stratified by metastatic status: patients with non-metastatic disease (M0, n=8) achieved a median OS of 46 months, whereas those presenting with distant metastasis (M1, n=2) had a significantly poorer median OS of only 3 months (log-rank p = 0.034).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[insert Figure 2 here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[insert table 3 here]\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe management of urachal anomalies in adults presents a distinct set of diagnostic and therapeutic challenges. In our cohort of 112 patients, the malignancy rate was 8.9%. This figure is notably lower than the 30\u0026ndash;60% reported in specialized cancer centers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], likely reflecting a more generalized prevalence in a tertiary setting that captures a broader spectrum of symptomatic benign cases. Our study confirmed that infection remains the predominant complication (72.3%), reinforcing the clinical paradigm that urachal remnants often remain quiescent until a secondary inflammatory event prompts medical attention.\u003c/p\u003e \u003cp\u003eDifferentiating between infected urachal cysts and carcinomas remains a formidable challenge due to overlapping radiological features. A pivotal finding of our study is the identification of gross hematuria and calcification as robust independent predictors of malignancy. Our multivariate analysis using Firth\u0026rsquo;s penalized regression revealed that patients presenting with gross hematuria had a 14-fold increased risk of carcinoma. This aligns with findings by Ashley and Bi reflecting the tumor's invasion through the bladder wall and mucosal ulceration a feature rarely seen in benign infections which typically drain via the umbilicus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Crucially, calcification emerged as a strong predictor. While peripheral \"egg-shell\" calcification can occur in chronic cysts, the presence of stippled or central calcifications on CT scans is highly suggestive of mucin-producing adenocarcinomas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These findings advocate for the mandatory use of CT/MRI in adults presenting with these risk factors to guide surgical planning, specifically the decision to perform a partial cystectomy.\u003c/p\u003e \u003cp\u003eRadical surgical resection remains the cornerstone of curative therapy. In our series, open surgery was performed in 73.9% of cases, a rate higher than contemporary laparoscopic series. This reflects the complexity of our cohort, characterized by large inflammatory masses, abscess formation, and locally advanced malignancies requiring extensive safety margins. Regarding the extent of resection, en-bloc partial cystectomy was performed in 80% of malignant cases. We strongly advocate for this aggressive approach not only for confirmed malignancies but also for indeterminate masses adherent to the bladder dome, as microscopic urachal remnants have been found within the bladder muscularis in up to 73% of cases, posing a significant risk for recurrence if a simple excision is performed [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prognosis of urachal carcinoma in our cohort was poor, with a 5-year OS of only 15%. This is significantly lower than 50% reported in Western series [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Several factors contribute to this disparity as late-stage presentation was predominant, with 90% of our patients diagnosed at stage pT3 or higher (Sheldon IIIA/IVB). This reflects the silent natural history of the disease in our population. Second, regarding adjuvant therapy, while 80% of our patients received platinum-based chemotherapy, the regimens varied (Gemcitabine-Cisplatin, FOLFOX, etc.) and some did not strictly adhere to current NCCN guidelines (5-FU/Platinum combinations, ITP) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The lack of standardized protocols and the aggressive biology of the tumors likely contributed to the suboptimal outcomes. This underscores the urgent need for centralized multidisciplinary management and adherence to evidence-based chemotherapy protocols to improve survival.\u003c/p\u003e \u003cp\u003ePelvic LND was performed in only 10% of our cases, primarily due to the lack of preoperative suspicion of malignancy in many patients. While the therapeutic benefit of LND remains debated, its prognostic value is indisputable. Given that nodal involvement is a critical determinant of survival, we now advocate for a more standardized approach to LND in all cases of suspected urachal carcinoma to ensure accurate staging.\u003c/p\u003e \u003cp\u003eStaging of urachal carcinoma remains a subject of debate. The Sheldon classification and modified TNM systems are most widely applied, although neither has been universally adopted [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our cohort, 70% of patients were classified as Sheldon stage IIIA and 30% as stage IVB, indicating a predominance of locally advanced and metastatic disease. This distribution closely mirrors prior studies showing that more than half of patients are present with stage III or IV disease. When mapped to TNM categories, 90% of our tumors were T3, with one patient exhibiting nodal metastasis and two presenting distant metastases (bone, peritoneum, and lymph nodes). These findings again reflect the silent natural history of UrC, where symptoms arise only after the tumor breaches the bladder dome or adjacent peritoneum.\u003c/p\u003e \u003cp\u003eRadical surgical resection remains the cornerstone of curative therapy for urachal carcinoma. The standard approach is partial cystectomy with en bloc removal of the urachus, umbilicus, and surrounding perivesical and peritoneal tissue, ensuring negative surgical margins [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our series, eight patients (80%) underwent urachal excision combined with partial cystectomy, while one patient underwent urachal excision alone and one underwent partial cystectomy alone. Open and laparoscopic approaches were used equally (five each), demonstrating that minimally invasive surgery is feasible in selected cases. None of our patients underwent concomitant umbilical excision, which diverges from many protocols advocating routine umbilectomy. Several large series have reported that including the umbilicus in the resection specimen improves local control and OS, suggesting that this step should be considered standard when technically feasible.\u003c/p\u003e \u003cp\u003ePelvic lymph-node dissection (PLND) was performed in only one patient. While PLND has limited therapeutic benefit, it plays an important staging and prognostic role [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Previous studies have shown that regional nodal involvement correlates with a markedly reduced survival comparable to that of distant metastasis. Therefore, standardized nodal assessment should be encouraged to better define disease burden and guide adjuvant therapy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study is subject to limitations inherent to its retrospective, single-center design. The small cohort of urachal carcinoma (n\u0026thinsp;=\u0026thinsp;10) inherently restricts statistical power; however, we mitigated this potential bias by employing Firth\u0026rsquo;s penalized likelihood regression, ensuring the robustness of the identified prognostic factors despite the limited number of events. Additionally, as a tertiary referral center, selection bias likely favors complex, locally advanced cases, which may explain the higher prevalence of open surgery and late-stage presentation compared to general populations. Finally, the heterogeneity of adjuvant chemotherapy regimens and the low rate of lymph node dissection limit our ability to draw definitive conclusions regarding the optimal multimodal management strategies. Despite these constraints, this study provides critical, previously unavailable data on the clinical profile and prognostic markers of urachal anomalies in the Vietnamese population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite these limitations, this study provides valuable data on the distinct clinical profile of urachal anomalies in the Vietnamese population. The identification of hematuria and calcification as key predictors should prompt aggressive diagnostic workup and radical surgery, potentially improving early detection and survival outcomes in this lethal disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUrC: Urachal carcinoma\u003c/p\u003e\n\u003cp\u003ePC: Partial cystectomy\u003c/p\u003e\n\u003cp\u003eTNM: Tumor, Node, Metastasis\u003c/p\u003e\n\u003cp\u003eCT: Computed tomography\u003c/p\u003e\n\u003cp\u003eMRI: Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation\u003c/p\u003e\n\u003cp\u003eIQR: Interquartile range\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003eOS: Overall survival\u003c/p\u003e\n\u003cp\u003eM0/M1: Metastasis (No/Yes)\u003c/p\u003e\n\u003cp\u003eLND: Lymph-node dissection\u003c/p\u003e\n\u003cp\u003ePLND: Pelvic lymph-node dissection\u003c/p\u003e\n\u003cp\u003eIRB: Institutional Review Board\u003c/p\u003e\n\u003cp\u003eNCCN: National Comprehensive Cancer Network\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis research was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City, (IRB-VN01002/IRB00010293/FWA00023448) with Approval No. 51/HĐĐĐ-ĐHYD, dated January 2, 2025.\u0026nbsp;The Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City waived the need for individual informed consent as this was a retrospective study using anonymized data.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eClinical Trial: Not applicable (retrospective study).\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eDe-identified clinical dataset and analysis code that support the findings are available from the corresponding author upon reasonable request, subject to institutional and national data-protection regulations.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNot applicable. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eStudy design:\u0026nbsp;Kinh Luan Thai\u003c/p\u003e\n\u003cp\u003eAcquisition of data: Phan Nhat Duy Le, Thanh Tuan Nguyen\u003c/p\u003e\n\u003cp\u003eDrafting of manuscript: Duy Le Phan Nhat\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript: Kinh Luan Thai, Xuan Thai Ngo\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional)\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAshley RA, Inman BA, Routh JC, et al. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. The Journal of urology. 2007;178(4 Pt 2):1615-8.\u003c/li\u003e\n\u003cli\u003eBruins HM, Visser O, Ploeg M, et al. The clinical epidemiology of urachal carcinoma: results of a large, population based study. The Journal of urology. 2012;188(4):1102-7.\u003c/li\u003e\n\u003cli\u003eSzarvas T, M\u0026oacute;dos O, Niedworok C, et al. Clinical, prognostic, and therapeutic aspects of urachal carcinoma-A comprehensive review with meta-analysis of 1,010 cases. Urologic oncology. 2016;34(9):388-98.\u003c/li\u003e\n\u003cli\u003eKe C, Hu Z, Yang C. Preoperative accuracy of diagnostic evaluation of urachal carcinoma. Cancer medicine. 2023;12(8):9106-9115.\u003c/li\u003e\n\u003cli\u003eBi X, Wu Z, Han H, et al. Clinical comparison of patients with benign urachal masses versus urachal carcinomas. Chin J Cancer. 2017;36(1):2.\u003c/li\u003e\n\u003cli\u003eDas JP, Vargas HA, Lee A, et al. The urachus revisited: multimodal imaging of benign \u0026amp; malignant urachal pathology. The British journal of radiology. 2020;93(1110):20190118.\u003c/li\u003e\n\u003cli\u003eHoshi A, Chihara I, Shiga M, et al. Laparoendoscopic single-site surgery for urachal remnant with extraperitoneal approach through a suprapubic port. Asian J Endosc Surg. 2022;15(3):569-576.\u003c/li\u003e\n\u003cli\u003eMylonas KS, P OM, Ziogas IA, et al. Malignant urachal neoplasms: A population-based study and systematic review of literature. Urologic oncology. 2017;35(1):33 e11-33 e19.\u003c/li\u003e\n\u003cli\u003eFlaig TW, Spiess PE, Abern M, et al. NCCN Guidelines\u0026reg; Insights: Bladder Cancer, Version 3.2024. J Natl Compr Canc Netw. 2024;22(4):216-225.\u003c/li\u003e\n\u003cli\u003eLimonnik V, Samiei A, Abel S, et al. Urachal carcinoma: A novel staging system utilizing the National Cancer Database. Cancer medicine. 2023;12(3):2752-2760.\u003c/li\u003e\n\u003cli\u003eHamilou Z, North S, Canil C, et al. Management of urachal cancer: A consensus statement by the Canadian Urological Association and Genitourinary Medical Oncologists of Canada. Canadian Urological Association journal = Journal de l\u0026apos;Association des urologues du Canada. 2020;14(3):E57-e64.\u003c/li\u003e\n\u003cli\u003eLoizzo D, Pandolfo SD, Crocerossa F, et al. Current Management of Urachal Carcinoma: An Evidence-based Guide for Clinical Practice. European urology open science. 2022;39:1-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Clinicopathological characteristics of benign versus malignant urachal anomalies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eUrachal anomalies n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUrachal cancer n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eAge (years) (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e39 (30 \u0026ndash; 51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e56 (45 - 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e53 (51.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e49 (48.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSymptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eGross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2 (1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eLow abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e47 (45.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eUmbilical discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e61 (59.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eLower urinary symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e12 (11.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eFever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e7 (6.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eUmbilical mass\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e33 (32.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eAsymptomatic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e7 (6.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eImaging Features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eMedian tumor size (cm) (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.25 (1.45 - 3.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e4 (3 \u0026ndash; 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eCalcification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3 (2.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eIrregular borders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e17 (16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e10 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eTumor location:\u003c/p\u003e\n \u003cp\u003eAnterior/ dome bladder wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e18 (17.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eMedical therapy (n = 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10 (9.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSurgery (n =102)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e92 (90.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e10 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eApproach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Open surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Laparoscopic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Robot-assisted laparoscopic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSurgical technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eUrachal excision\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003ePartial cystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eUmbilectomy performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIQR: interquartile range, PC: Partial cystectomy\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eUnivariable logistic regression analysis of predictors for urachal.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eOR (95% Cl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eAge \u0026gt; 55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3.3 (0.9 \u0026ndash; 12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eLower urinary tract symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e5.0 (1.2 \u0026ndash; 20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eGross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e16.7 (3.4 \u0026ndash; 82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eLow abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e0.3 (0.1 \u0026ndash; 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eCalcification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e16.7 (3.4 \u0026ndash; 82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eIrregular borders\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e57.9 (3.2 \u0026ndash; 1044.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eAnterior/dome bladder wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e5.0 (1.3 \u0026ndash; 20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eCI: confidence interval; OR: odds ratio.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Clinicopathological characteristics, staging, and treatment of urachal carcinoma\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1064\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eTumour location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSize (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003ePreoperative diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eProcedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eApproach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003ePLND\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eUmbilectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eTNM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eSheldon\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eChemothapary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eNo. of cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eUrachus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eInfected urachal cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT1N0M1 (peritoneum)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIVB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUrachal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eLap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBladder tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eLap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIVB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eAnterior bladder wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUrachal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Carboplatin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUrachal carcinoma, ycT3N2M1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N2M1 (bone and nodal metastases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIVB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eLeucovorin + 5‑FU + Oxaliplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eUrachus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBladder tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eLap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUrachal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Carboplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eAnterior bladder wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUrachal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBladder tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003ePC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eBladder dome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBladder tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eUrachal excision with PC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eLap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eSmall-cell neuroendocrine carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eT3N0M0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eIIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eEtoposide + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"urachal anomalies, urachal carcinoma, urachal neoplasm, prognostic factor","lastPublishedDoi":"10.21203/rs.3.rs-8300930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8300930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Urachal anomalies are rare entities in the adult population with significant malignant potential. This study aims to comprehensively describe clinical and paraclinical characteristics, as well as to analyze and evaluate prognostic factors for urachal carcinoma, thereby facilitating early diagnosis and effective management\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a retrospective, cross-sectional study on patients diagnosed with urachal anomalies from 2017 to 2025. Data regarding clinical characteristics, imaging findings, treatment modalities, and clinical outcomes were collected for both benign and malignant cases. Additionally, survival outcomes were specifically analyzed for patients with urachal carcinoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 112 patients were included, comprising 8.9% cases of urachal carcinoma, while infection was the predominant presentation (72.3%).\u003cstrong\u003e \u003c/strong\u003eSurgical management differed significantly by pathology, with urachal excision and partial cystectomy performed in 80.0% of malignant cases versus 23.9% of benign cases. Multivariate logistic regression identified hematuria (OR 14.1; 95% CI 1.3–153.6; p=0.03) and calcification (OR 13.5; 95% CI 1.7–109.2; p=0.01) as significant independent predictors of malignancy. Histologically, adenocarcinoma was the major subtype (80%), with most tumors being Sheldon stage IIIA or IV. Overall survival (OS) showed a steep decline, recorded at 90.0%, 60.0%, and 15.0% at 1, 3, and 5 years, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Gross hematuria and calcification serve as critical, independent predictors of urachal malignancy. Given the aggressive nature and poor overall prognosis (5-year OS of only 15.0%), the presence of these indicators necessitates an aggressive diagnostic workup \u003csup\u003e33\u003c/sup\u003eand prompt radical surgical intervention (en-bloc urachal excision with partial cystectomy) to optimize long-term patient outcomes.\u003c/p\u003e","manuscriptTitle":"Gross Hematuria and Calcification as Independent Predictors of Urachal Carcinoma in Adults: A Single-Center Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 00:34:17","doi":"10.21203/rs.3.rs-8300930/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T09:32:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T23:23:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T19:28:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88221110974402592308898428772708351360","date":"2026-02-26T19:01:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338648999554407636015884695704121077997","date":"2026-02-24T19:59:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T14:21:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303369491823880512466210156704119813081","date":"2026-02-05T05:30:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335904633770265658399368854773867998954","date":"2026-02-04T20:26:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T20:22:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T11:14:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-09T11:13:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-12-07T15:58:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75c2139d-02a6-4809-86dd-8712437e33e1","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T15:39:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 00:34:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8300930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8300930","identity":"rs-8300930","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}