ABSTRACT
Renal and bladder ultrasound is a requisite part of the initial evaluation in the newborn with prune belly syndrome (PBS). A spectrum of renal abnormalities may be seen, from normal kidneys to bilateral dysplasia. Dysplasia is present in up to 50% of cases but varies in both severity and laterality. Severely dysplastic kidneys are usually associated with bladder outlet obstruction. Poor bladder contractility in PBS patient may lead to incomplete and infrequent emptying. In turn, this exacerbates urinary stasis and vesicoureteral reflux. Reduction cystoplasty has been proposed to reduce bladder volume, create more spherical shape, and improve the contractibility of the bladder. Pelvic osteotomy performed at the time of initial closure offers several advantages, including easy approximation of pubic diastasis with decreased tension on the abdominal wall. Cloacal exstrophy, like bladder exstrophy, is an anterior wall defect but has a rarer incidence of 1 : 200 000 to 1 : 400 000, and associated defects are typically increased in severity.
