Carcinoma of the Urachus

SUMMARY Two further cases of urachal carcinoma are added to the 76 already reported in the English literature. An important factor contributing to the poor prognosis appears to be inadequate excision of the tumour at the time of partial cystectomy. No tumour at the apex of the bladder should be treated endoscopically without a tissue diagnosis; if biopsy reveals adenocarcinoma the urachus is the most likely site of origin. Treatment entails en bloc excision of the transversalis fascia, the fatty tissue in the cave of Retzius and an adequate margin of bladder wall together with the overlying peritoneum. Radiotherapy has little to offer for the early case but may be a useful adjunct to surgery in the presence of advanced disease.