Surgical Management of the Urinary Tract for the Prune-Belly (Triad) Syndrome

Abstract

Urinary reconstruction is tempting based on the impressive abnormal findings that are revealed on imaging. The abnormal appearance of the urinary system by itself is not enough to warrant reconstruction. Reconstruction should only be undertaken when there is clear clinical evidence that stagnant urine leads to urinary tract infections and/or obstruction that is associated with renal compromise. This chapter describes temporary and permanent upper and lower urinary reconstructions. Particular consideration is given to the pathophysiology of prune belly syndrome and the disproportionate dilation and dysfunction of the distal ureter when undertaking ureteral remodeling. The techniques of ureteral folding and formal excisional ureteral tapering are described stressing the importance of vascular preservation. The role of reduction cystoplasty is placed in perspective of short- and long-term benefits. This review contains 18 references. Key Words: Eagle-Barrett syndrome, megacystis, megaureter, prune-belly syndrome, tapered ureteral reimplant, triad syndrome, ureteral reconstruction, urinary diversion, bladder reduction.