Urachal anomalies are rare with an incidence of 1:5000-8000 live births. There is still some controversy as to whether to treat them expectantly or surgically with published reports describing malignant changes in adulthood. These authors describe their retrospective series of 13 children with urachal anomalies over an 11-year period. Nine were symptomatic (six with cysts and three with patent urachus), age at presentation was between one day and fourteen years (median six years). In their series, conservative management was used in 12/13 patients. Spontaneous resolution occurred in 61.5% with the median time to resolution being 16.5 months. Two cases that originally presented with infection and which were treated conservatively, re-presented with further infection. Two cases were still being followed up after parents refused operative treatment on failure of resolution after four years and six years. The authors conclude that an initial conservative approach to urachal anomalies is appropriate given the high resolution rate, low malignancy incidence in the long term (although their series only had relatively short follow-up and not into adulthood) and that serial ultrasound surveillance is reasonable. If surgery is contemplated, then the laparoscopic approach is the preferred option.