Abstract
Background
Prenatal detection of isolated ascites in combination with an abdominal cyst poses a diagnostic challenge. The diagnosis of urachal remnants may be particularly difficult, as imaging findings can mimic other urinary tract anomalies. Furthermore, their rarity has resulted in a lack of clear evidence-based management guidelines.
Methods
A literature review was conducted to understand this clinical presentation. The Medline database (PubMed) was searched using the MeSH terms “Ascites/congenital,” “Urachal Cyst,” and “Urethral Obstruction/congenital.” A total of 979 publications were screened.
Results
Urachal cysts are rare embryological remnants that are often asymptomatic and may regress spontaneously, supporting conservative management in selected paediatric cases. In contrast, posterior urethral valves require prompt diagnosis using voiding cystourethrography, followed by valve ablation. Long-term follow-up of these patients is essential, as up to 20% of affected patients may progress to end-stage renal disease.
Discussion
Early recognition of this rare combination of findings may facilitate timely diagnosis of posterior urethral valves and guide appropriate postnatal management. In this case, the urachal cyst may have acted as a pressure-relieving “pop-off” mechanism. This might explain the absence of hydronephrosis and could have potentially protected the renal function. Clinical follow-up will be necessary to determine whether this presumed pressure-relief mechanism translates into a more favourable long-term renal prognosis.