Urachal carcinoma (UC) is a rare and aggressive malignancy originating from the urachus, a vestigial structure connecting the bladder to the umbilicus (1). Surgical resection, often involving partial or total cystectomy, is the cornerstone of treatment. Despite its central role in management, the long-term impact of these surgical interventions on bladder function remains poorly characterized (2). This study investigates postoperative bladder function in patients with UC, with a focus on urinary continence, bladder capacity, and quality of life.

This systematic review was conducted in accordance with PRISMA 2020 guidelines and aimed to evaluate postoperative bladder function in patients with UC undergoing surgical resection, with a focus on urinary continence, bladder capacity, and quality of life. A comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus was performed for studies published between January 1990 and present. Eligible studies included adults with UC who underwent partial or total cystectomy and reported postoperative bladder function outcomes. Observational studies, interventional trials, and case series with ≥5 patients were included. Reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, or Cochrane Risk of Bias Tool, as appropriate.

A comprehensive review of clinical outcomes in UC patients who underwent cystectomy revealed a spectrum of bladder-related complications. Patients treated with partial cystectomy generally maintained near-normal bladder function, though some reported increased urinary frequency and urgency. In contrast, total cystectomy was associated with more significant dysfunction, including urinary incontinence, decreased bladder capacity, and the need for urinary diversion (3). Preoperative tumor involvement of the bladder was a major predictor of postoperative bladder outcomes. Bladder reconstruction techniques, such as neobladder formation, demonstrated potential for preserving function; however, complications like urinary tract infections and incontinence remained common and required careful management.

-

Surgical management of urachal carcinoma, particularly cystectomy, significantly influences long-term bladder function. Partial cystectomy is associated with more favorable functional outcomes, while total cystectomy often results in substantial bladder impairment. Bladder reconstruction techniques offer potential benefits but necessitate vigilant postoperative care to manage complications. A deeper understanding of surgical impacts on bladder function is essential for optimizing treatment strategies and enhancing quality of life for UC survivors. Ongoing research should aim to refine surgical and reconstructive approaches and establish long-term support pathways for patients facing bladder-related challenges.

Loizzo D, Pandolfo SD, Crocerossa F, Guruli G, Ferro M, Paul AK, Imbimbo C, Lucarelli G, Ditonno P, Autorino R. Current Management of Urachal Carcinoma: An Evidence-based Guide for Clinical Practice. Eur Urol Open Sci. 2022 Mar 14;39:1-6. doi: 10.1016/j.euros.2022.02.009. PMID: 35309098
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. Urol Oncol. 2016;34:388–398. doi: 10.1016/j.urolonc.2016.04.012.
Shao G., Xu C., Liu J., et al. Clinical, pathological, and prognostic analysis of urachal carcinoma. Urol Int. 2022;106:199–208. doi: 10.1159/000518028.