Current management of the dilated urinary tract in prune belly syndrome.

Upper urinary tract stasis, poor bladder emptying, vesicoureteral reflux, and bacteriuria in various combinations are the factors that have led to a poor long-term prognosis in patients with prune belly syndrome. Whether these factors are best controlled by medical treatment or by surgical correction has been the source of some controversy. Although medical treatment may have improved over the years, so have the results of reconstructive surgery. Because the syndrome is a spectrum disorder, there will certainly be many patients who require little or no surgical intervention. The majority, however, will benefit from carefully planned and well-executed reconstructive surgery. Even in these cases, there should be a period of medical treatment and surveillance with interval re-evaluation. In a few patients, early stabilization will not be possible, and a drainage procedure such as vesicostomy will be necessary in the first days of life. Regardless of how an individual patient might be treated, he will require long-term follow-up surveillance. As more long-term results are reported, the optimal treatment plan should become more obvious.