DISCUSSION Dr. David A. Diamond. We were finding small urachal remnants on many of the ultrasounds when evaluating children for urinary tract infection. How do you distinguish urachal remnants that may be an etiology of an infection from those that are simply found incidentally on ultrasound evaluation of these children? Dr. Vincenzo Galati. That is a tough question to answer. It is interesting when we asked the radiologists at our institution about urachal remnants they do not even comment because they are so small and we never actually know about them. I am not really sure whether those need to be managed. Dr. George Klauber. Although you reported good results, I was wondering if there could be any selection bias in terms of a surgeon selecting a certain procedure because he/she thought it was most appropriate for a specific type of ureterocele based on size or based on a nonfunctioning moiety associated with ureterocele. Could you enlighten us? Dr. Jane M. Lewis. The fortune that we had is that at least 2 of our surgeons were pretty set in their ways, meaning whichever case came their way they performed one versus the other procedure. A couple of our surgeons would perform one versus the other and that bias certainly could play in their choices since they would use both techniques. That is something we should address in the final manuscript. Dr. Howard Snyder. One of the handicaps of being at it as long as I have is I have had 2 late teenagers, kids that were young adults, referred to me with bladder cancer presumably in a urachal remnant. Both of them did not have that but they had big phlegmonous masses that had become infected in obviously a residual urachal cyst. And remember these tiny, little cysts, if they maintain any epithelial tract to either the skin of the bottom of the umbilicus or to the bladder, may get infected. I think that when you ignore one of these things, you should warn a family that it is conceivable that some problem might occur in the future and be aware that it is there. Because both of these kids were referred to me with a cancer diagnosis caused considerable consternation. I actually ended up having to do a little bit of a domectomy to remove the phlegmonous masses. They were really impressive. MANAGEMENT OF URACHAL REMNANTS IN EARLY CHILDHOOD 1827

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DISCUSSION

Dr. David A. Diamond. We were finding small urachal remnants on many of the ultrasounds when evaluating children forurinary tract infection. How do you distinguish urachal remnants that may be an etiology of an infection from those that aresimply found incidentally on ultrasound evaluation of these children?

Dr. Vincenzo Galati. That is a tough question to answer. It is interesting when we asked the radiologists at our institutionabout urachal remnants they do not even comment because they are so small and we never actually know about them. I amnot really sure whether those need to be managed.

Dr. George Klauber. Although you reported good results, I was wondering if there could be any selection bias in terms ofa surgeon selecting a certain procedure because he/she thought it was most appropriate for a specific type of ureterocele basedon size or based on a nonfunctioning moiety associated with ureterocele. Could you enlighten us?

Dr. Jane M. Lewis. The fortune that we had is that at least 2 of our surgeons were pretty set in their ways, meaningwhichever case came their way they performed one versus the other procedure. A couple of our surgeons would perform oneversus the other and that bias certainly could play in their choices since they would use both techniques. That is somethingwe should address in the final manuscript.

Dr. Howard Snyder. One of the handicaps of being at it as long as I have is I have had 2 late teenagers, kids that wereyoung adults, referred to me with bladder cancer presumably in a urachal remnant. Both of them did not have that but theyhad big phlegmonous masses that had become infected in obviously a residual urachal cyst. And remember these tiny, littlecysts, if they maintain any epithelial tract to either the skin of the bottom of the umbilicus or to the bladder, may get infected.I think that when you ignore one of these things, you should warn a family that it is conceivable that some problem mightoccur in the future and be aware that it is there. Because both of these kids were referred to me with a cancer diagnosis causedconsiderable consternation. I actually ended up having to do a little bit of a domectomy to remove the phlegmonous masses.They were really impressive.

MANAGEMENT OF URACHAL REMNANTS IN EARLY CHILDHOOD 1827