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Keet K, Henry BM, Tubbs RS. Prune-belly syndrome in Africa: An analysis and systematic review of cases, etiology, treatment, and outcomes. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820903196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prune-belly syndrome is a rare congenital disorder characterized by a spectrum of three anomalies: bilateral undescended testes, dilated urinary tract, and anterior abdominal muscle deficiency. Objectives: In developing countries, inadequate access to health care may affect treatment and outcomes of prune-belly syndrome. This study’s goal was to review the anatomical features, etiology, genetics, management, and outcomes of cases in Africa. Methods: PubMed was searched to identify case reports and case studies describing prune-belly syndrome in Africa. Data collected from each study included the number of cases, age at diagnosis, sex, description of the abdominal muscles, testes, and urinary tract, as well as associated anomalies, management, and long-term outcomes. Results: A total of 16 publications that reported 58 cases in African countries were included. The prevalence of female patients (15.5%) was higher than in developed countries (3%). The abdominal muscles were deficient in all cases, and bilateral cryptorchidism was present in nearly all males (96%). Distension of the bladder was common, with normal anatomy reported in only one case. Bilateral hydroureters and hydronephrosis also were present in the majority of cases. Only six cases (10.3%) had no associated anomalies, such as musculoskeletal or cardiovascular. Karyotyping was performed in only three cases (5.2%) because of limited hospital facilities. Six parents (10.3%) declined treatment for their children, 12 cases (20.7%) were managed conservatively, and 25 (43.1%) received surgical intervention. Patients’ mortality rate was higher than in developed countries. Conclusion: Diagnosis and treatment of prune-belly syndrome remains a challenge in Africa, in which multiple factors, such as access to health care and cultural beliefs, affect mortality rates and outcomes. Patient education and support groups may improve compliance with treatment. Level of evidence: Not applicable for this multicenter audit.
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Affiliation(s)
- Kerri Keet
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, USA
| | - R Shane Tubbs
- Departments of Neurosurgery and Structural and Cellular Biology, Tulane University School of Medicine, USA
- Department of Anatomical Sciences, St. George’s University, Grenada
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Kessy JP, Philemon RN, Hamel BC. Two cases of Prune Belly Syndrome from Kagera Region Tanzania. East Afr Health Res J 2020; 4:20-25. [PMID: 34308216 PMCID: PMC8279232 DOI: 10.24248/eahrj.v4i1.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/07/2020] [Indexed: 11/26/2022] Open
Abstract
Prune Belly Syndrome is a rare congenital disorder with unknown aetiology, consisting of a triad of abdominal muscle wall weakness, undescended testes, and urinary tract abnormalities. We are unaware of any preceding report of Prune Belly Syndrome in Tanzania, and here we describe two cases reported in Kagera region. The first case is a 2 month old boy with the triad of Prune Belly Syndrome along with pectus carinatum who died due to septicaemia. This case posed a diagnostic challenge at birth and during the natal period. Paucity of comprehensive knowledge of congenital malformations at the peripheral health facilities may have also contributed to the diagnostic challenge in the first place. The second case is a neonate who was referred to regional referral hospital where he was diagnosed with Prune Belly Syndrome at the age of four weeks. Because of limited capacity to manage congenital malformations at the regional referral hospital, he was referred to an urologist at the zonal referral hospital. However, inadequacies in supporting systems to the parents compounded care of the neonate with Prune Belly Syndrome. High index of Prune Belly Syndrome suspicion is needed in a resource limited setting in order to timely make diagnosis. There is also a need to strengthen institutional and individual's capacity for prenatal screening to detect congenital anomalies at an early stage of foetus development. Multidisciplinary management approach is necessary in order to improve the quality of life for patients with Prune Belly Syndrome. Psychosocial and medical support systems should be put in place in order to enhance preparedness for patient care in resource limited settings including equipping the referral hospital with different specialists and ensuring availability of basic investigations for patients.
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Affiliation(s)
- Jonas P Kessy
- Bukoba Regional Referral Hospital, Paediatric and Child Health Department, Bukoba, Tanzania
| | - Rune N Philemon
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ben C Hamel
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Alkhamis WH, Abdulghani SH, Altaki A. Challenging diagnosis of prune belly syndrome antenatally: a case report. J Med Case Rep 2019; 13:198. [PMID: 31253193 PMCID: PMC6599311 DOI: 10.1186/s13256-019-2120-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
Background Prune belly syndrome is a rare congenital condition of uncertain etiology. It is characterized with a triad of abdominal distension due to deficient abdominal wall, genitourinary tract anomalies, and musculoskeletal anomalies. This condition varies in its severity which makes diagnosis challenging during early antenatal scanning. Case presentation We reported a severe phenotype of prune belly syndrome which was not fully suspected in a 29-year-old Saudi woman was G4T2P0A1L2 at 21 weeks of gestation at the time of early antenatal presentation; however, it became apparent during diagnosis at a subsequent follow-up scan during advanced gestational age. Conclusion We conclude that suspicion of such anomalies through an early antenatal scan require an urgent further follow-up scan in a tertiary center. The referral to the tertiary center must be to an experienced ultrasonographer and maternal–fetal medicine specialist for a decision to be made antenatally regarding the course of pregnancy and post-delivery management based on the severity of the condition.
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Affiliation(s)
- Waleed H Alkhamis
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, King Saud University Medical City, P.O BOX 4663, 11412, Riyadh City, Almohammadiyah, Kingdom of Saudi Arabia
| | - Sahar Hassan Abdulghani
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, King Saud University Medical City, P.O BOX 4663, 11412, Riyadh City, Almohammadiyah, Kingdom of Saudi Arabia.
| | - Amer Altaki
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, King Saud University Medical City, P.O BOX 4663, 11412, Riyadh City, Almohammadiyah, Kingdom of Saudi Arabia
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Valappil B, Krishna L, Sreedharan R, Shetty A. Exploration of the fetus with gross anomaly: a case of pseudo prune belly syndrome. Anat Cell Biol 2018; 51:205-208. [PMID: 30310713 PMCID: PMC6172593 DOI: 10.5115/acb.2018.51.3.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022] Open
Abstract
Prune belly syndrome is a rare congenital anomaly usually presented with triad characteristic feature of deficient abdominal muscles, cryptorchidism, and urinary tract anomalies. Here, we present a case with all the characteristic features of prune belly and the associated secondary features which were observed on detailed dissection and exploration of the fetus.
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Affiliation(s)
- Bhagyam Valappil
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Lalu Krishna
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Ranjith Sreedharan
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Ashwija Shetty
- Department of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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White JT, Sheth KR, Bilgutay AN, Roth DR, Austin PF, Gonzales ET, Janzen NK, Tu DD, Mittal AG, Koh CJ, Ryan SL, Jorgez C, Seth A. Vesicoamniotic Shunting Improves Outcomes in a Subset of Prune Belly Syndrome Patients at a Single Tertiary Center. Front Pediatr 2018; 6:180. [PMID: 30018947 PMCID: PMC6038357 DOI: 10.3389/fped.2018.00180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/01/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Review outcomes of Prune Belly Syndrome (PBS) with the hypothesis that contemporary management improves mortality. Methods: A retrospective chart review of inpatient and outpatient PBS patients referred between 2000 and 2018 was conducted to assess outcomes at our institution. Data collected included age at diagnosis, concomitant medical conditions, imaging, operative management, length of follow-up, and renal function. Results: Forty-five PBS patients presented during these 18 years. Prenatal diagnoses were made in 17 (39%); 65% of these patients underwent prenatal intervention. The remaining patients were diagnosed in the infant period (20, 44%) or after 1 year of age (8, 18%). Twelve patients died from cardiopulmonary complications in the neonatal period; the neonatal mortality rate was 27%. The mean follow-up among patients surviving the neonatal period was 84 months. Forty-two patients had at least one renal ultrasound (RUS); of the 30 patients with NICU RUSs, 26 (89%) had hydronephrosis and/or ureterectasis. Of the 39 patients who underwent voiding cystourethrogram (VCUG), 28 (62%) demonstrated VUR. Fifty-nine percent had respiratory distress. Nine patients (20%) were oxygen-dependent by completion of follow up. Thirty-eight patients (84%) had other congenital malformations including genitourinary (GU) 67%, gastrointestinal (GI) 52%, and cardiac 48%. Sixteen patients (36%) had chronic kidney disease (CKD) of at least stage 3; three patients (7%) had received renal transplants. Eighty-four percent of patients had at least one surgery (mean 3.4, range 0-6). The most common was orchiopexy (71%). The next most common surgeries were vesicostomy (39%), ureteral reimplants (32%), abdominoplasty (29%), nephrectomy (25%), and appendicovesicostomy (21%). After stratifying patients according to Woodard classification, a trend for 12% improvement in mortality after VAS was noted in the Woodard Classification 1 cohort. Conclusions: PBS patients frequently have multiple congenital anomalies. Pulmonary complications are prevalent in the neonate while CKD (36%) is prevalent during late childhood. The risk of CKD increased significantly with the presence of other congenital anomalies in our cohort. Mortality in childhood is most common in infancy and may be as low as 27%. Contemporary management of PBS, including prenatal interventions, reduced the neonatal mortality rate in a subset of our cohort.
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Affiliation(s)
- Jeffrey T White
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Kunj R Sheth
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Aylin N Bilgutay
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - David R Roth
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Paul F Austin
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Edmond T Gonzales
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Nicolette K Janzen
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Duong D Tu
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Angela G Mittal
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Chester J Koh
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Sheila L Ryan
- Memorial Hermann Health System, Houston, TX, United States
| | - Carolina Jorgez
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Abhishek Seth
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.,Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
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