Prune belly syndrome

  • Definition
    • Prune belly syndrome is a group of birth defects that involves these 3 main problems:

      • Poor development of the abdominal muscles, causing the skin of the belly area to wrinkle like a prune
      • Undescended testicles
      • Urinary tract problems
  • Alternative Names
    • Eagle-Barrett syndrome; Triad syndrome; Urethral obstruction malformation sequence

  • Causes
    • The causes of prune belly syndrome are unknown. The condition affects mostly boys.

      While in the womb, the developing baby's abdomen swells with fluid. Often, the cause is a problem in the urinary tract. The fluid disappears after birth, leading to a wrinkled abdomen that looks like a prune. This appearance is more noticeable due to the lack of abdominal muscles.

  • Symptoms
    • Weak abdominal muscles can cause:

      • "Little Buddha" appearance
      • Constipation
      • Delay in sitting and walking
      • Difficulties coughing

      Urinary tract problems can cause difficulty urinating.

  • Exams and Tests
    • A woman who is pregnant with a baby who has prune belly syndrome may not have enough amniotic fluid (the fluid that surrounds the fetus). This can cause the infant to have lung problems from being compressed in the womb.

      An ultrasound done during pregnancy may show that the baby has a swollen bladder or enlarged kidney.

      In some cases, a pregnancy ultrasound may also help determine if the baby has:

      • Heart problems
      • Abnormal bones or muscles
      • Stomach and intestinal problems
      • Underdeveloped lungs

      The following tests may be performed on the baby after birth to diagnose the condition:

  • Treatment
    • Early surgery is recommended to fix weak abdominal muscles, urinary tract problems, and undescended testicles.

      The baby may be given antibiotics to treat or help prevent urinary tract infections.

  • Outlook (Prognosis)
    • Prune belly syndrome is a serious and often life-threatening problem.

      Many infants with prune belly syndrome are either stillborn or die within the first few weeks of life. The cause of death is from severe lung or kidney problems, or from a combination of birth problems.

      Some newborns survive and can develop normally. Others continue to have many medical and developmental problems.

  • Possible Complications
    • Complications depend on the related problems. The most common are:

      • Constipation
      • Bone deformities (clubfoot, dislocated hip, missing limb, finger, or toe, funnel chest)
      • Disease of the urinary tract (may need dialysis and a kidney transplant)

      Undescended testicles can lead to infertility or cancer.

  • When to Contact a Medical Professional
    • Prune belly syndrome is usually diagnosed before birth or when the baby is born.

      If you have a child with diagnosed prune belly syndrome, call your health care provider at the first sign of a urinary tract infection or other urinary symptoms.

      If a pregnancy ultrasound shows that your baby has a swollen bladder or enlarged kidneys, talk to a specialist in high-risk pregnancy or perinatology.

  • Prevention
    • There is no known way to prevent this condition. If the baby is diagnosed with a urinary tract obstruction before birth, in rare cases, surgery during the pregnancy may help prevent the problem from progressing to prune belly syndrome.

  • References
    • Caldamone AA, Woodard JR. Prune belly syndrome. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 123.

      Elder JS. Obstruction of the urinary tract. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 540.