Prune Belly Syndrome
Prune belly (Eagle–Barrett) syndrome is the triad of deficient abdominal-wall musculature, bilateral undescended testes, and a dilated urinary tract — management centres on protecting renal function and treating infection, with surgery individualised rather than reflexive.
The big picture
Prune belly syndrome (Eagle–Barrett syndrome), almost exclusively in males, is defined by a classic triad: deficient/absent anterior abdominal-wall muscles (giving the wrinkled 'prune' appearance), bilateral undescended (intra-abdominal) testes, and a dilated urinary tract (large hypotonic bladder, dilated tortuous ureters, often with reflux). Severity ranges widely; the most severe have renal dysplasia and, if associated with oligohydramnios, pulmonary hypoplasia that dominates the neonatal course.
Prune belly = abdominal-wall deficiency + bilateral undescended testes + dilated (usually non-obstructive) urinary tract — manage function-first (renal preservation, infection control), individualising surgery rather than reflexively correcting dilation.
Symptom sorter
Recognise it.
Diagnostic algorithm
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Treatment ladder
Function-led care: protect renal function, control infection and ensure emptying, with individualised surgery rather than reflexive correction of dilation.
Complications
- Chronic kidney disease/renal failure, recurrent UTIs, infertility and testicular cancer risk, respiratory issues (pulmonary hypoplasia)
- Surgical complications of reconstruction/orchidopexy/abdominoplasty
- Function-first management, infection control, judicious surgery
- Treat genuine obstruction/reflux; renal support; lifelong follow-up
Follow-up
- Renal function and upper tracts
- UTIs and bladder emptying
- Testicular position (cancer awareness), abdominal-wall function
- Lifelong surveillance, especially renal
- Preserved renal function, controlled infections, adequate emptying
- Renal deterioration, recurrent UTIs, genuine obstruction
- Surveillance and on deterioration
- Chronic kidney disease, infertility/cancer risk (undescended testes), abdominal-wall and respiratory issues
Memory hooks
Triad: prune wall + undescended testes + dilated tract.
Dilation is usually non-obstructive.
Function-first: kidneys, infection, emptying.
Surgery individualised, not reflexive.
Almost always male.
Board traps
Prune belly dilation is usually non-obstructive.
Triad: abdominal-wall deficiency, bilateral undescended testes, dilated urinary tract.
Pulmonary hypoplasia (oligohydramnios) can dominate the neonatal course.
Clinical cases
A male neonate has a lax, wrinkled abdominal wall, impalpable testes, and markedly dilated ureters and bladder on ultrasound. A renogram shows no significant obstruction.
What is the diagnosis and the management principle?