Prune Belly Syndrome Workup

Updated: Jun 23, 2017
  • Author: Israel Franco, MD, FAAP, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Laboratory Studies

See the list below:

  • 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

See the list below:

  • 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.