eMedicine Specialties > Urology > Congenital Urologic Conditions

Prune Belly Syndrome: Workup

Author: Israel Franco, MD, FAAP, FACS, Associate Professor, Department of Urology, Division of Pediatric Urology, New York Medical College; Director of Pediatric Urology, Lincoln Hospital and Medical Center
Contributor Information and Disclosures

Updated: Oct 29, 2009

Workup

Laboratory Studies

  • Obtain a sequential multiple analysis (SMA-6; ie, 6 different serum tests and creatinine tests to evaluate renal function in a serial fashion) because many children with prune belly syndrome may have renal compromise.
  • Urinary output and electrolytes must be carefully observed in newborns. A rise in BUN and creatinine levels associated with decreased urine output indicates obstruction.

Imaging Studies

  • Careful radiologic evaluation is essential before committing to any type of diverting procedure.
  • Radiologic studies should be performed in the newborn period, regardless of whether obstruction is present.
  • Kidney, ureter, and bladder (KUB) test findings can usually be used for diagnosis based on the typical appearance of the bowels hanging over the lateral edge of the abdominal wall.
  • The first study that should be performed is renal and bladder ultrasonography, which is a noninvasive procedure and can be used later to noninvasively monitor the child's progress.
  • Perform ultrasonography of the kidneys as early as possible to evaluate the upper tracts.
  • Renal scan is necessary after renal function stabilizes to evaluate renal function and drainage.
  • Contrast voiding cystourethrography (VCUG) should be performed.
    • VCUG is used to delineate the prostate-membranous urethra and the bladder and to detect the presence of an urachal remnant. In addition, the patient is evaluated for vesicoureteral reflux. Patients with vesicoureteral reflux are placed on antibiotic prophylaxis.
    • Upon evidence of upper-tract dilatation or obstruction, a renal Hippuran or diethylenetriamine pentaacetic acid (DTPA) study should be performed.
    • Children with only megaureter, megacystis, and the prostatic abnormalities who have no evidence of obstruction or reflux can be managed conservatively with close observation.
    • VCUG is necessary to evaluate the bladder size. In addition, urethral stenosis must be ruled out immediately. The presence of a patent urachus is a hint that stenosis is present. The degree and extent of reflux is assessed with this study.

More on Prune Belly Syndrome

Overview: Prune Belly Syndrome
Workup: Prune Belly Syndrome
Treatment: Prune Belly Syndrome
Follow-up: Prune Belly Syndrome
Multimedia: Prune Belly Syndrome
References
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References

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Further Reading

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Keywords

prune belly syndrome, PBS, Eagle-Barrett syndrome, triad syndrome, undescended testis, undescended testes, abdominal wall reconstruction, percutaneous nephrostomy, standard pyeloplasty, infravesical obstruction, obstruction at the prostatic urethra, trisomy 18, trisomy 21, tetralogy of Fallot, TF, ventriculoseptal defect, ventricular septal defect

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Contributor Information and Disclosures

Author

Israel Franco, MD, FAAP, FACS, Associate Professor, Department of Urology, Division of Pediatric Urology, New York Medical College; Director of Pediatric Urology, Lincoln Hospital and Medical Center
Israel Franco, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association, Endourological Society, International Pediatric Endosurgery Group, Medical Society of the State of New York, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Peter Langenstroer, MD, Associate Professor, Department of Urology, Medical College of Wisconsin
Peter Langenstroer, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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