Prune-belly syndrome in Africa: An analysis and systematic review of cases, etiology, treatment, and outcomes

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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A rare case report of prune belly syndrome with malnutrition

Oxford Medical Case Reports ◽

10.1093/omcr/omab017 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

Turyalai Hakimi ◽

Mohammad Akbar Ibrahimi

Keyword(s):

Urinary Tract ◽

Family Medicine ◽

Rural Areas ◽

Valsalva Maneuver ◽

Unknown Etiology ◽

Abdominal Muscles ◽

Prune Belly Syndrome ◽

Prune Belly ◽

Tract Infections ◽

Urinary Tract Malformations

ABSTRACT Prune belly syndrome (PBS) is a rare congenital malformation of unknown etiology characterized by a triad of deficient abdominal wall musculature, undescended testicles and urinary tract malformations. Most of the patients have pulmonary, cardiac, skeletal and gastrointestinal tract anomalies. Lack of abdominal muscles leads to constipation due to inability to perform Valsalva maneuver, which helps push the stool out of the rectum during the defecation. Additionally, frequent respiratory tract infections, persisting constipation and urinary tract infections lead to the development of malnutrition in children. We report this case to raise the awareness of low socioeconomic and low-resource medical settings that malnutrition could be existed or caused by PBS. We also encourage the expansion of pediatric surgery and family medicine training to increase the number of specialist (family medicine) to report and refer PBS in earlier phase, while working in rural areas and remote provinces.

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A Nation of Uninsured Immigrants

Health of Newcomers ◽

10.18574/nyu/9780814789216.003.0005 ◽

2017 ◽

Author(s):

Patricia Illingworth ◽

Wendy E. Parmet

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care System ◽

Access To Health Care ◽

Developed Countries ◽

The United States ◽

Public Benefits ◽

Access To Health ◽

Treat All ◽

Care System

The United States is unique among developed countries in not providing health insurance to all of its citizens. But newcomers, both legal and undocumented, are far more likely to be uninsured than natives. This chapter reviews US law, including the Affordable Care Act, regarding immigrants’ access to health insurance, exposing the conflicting and inconsistent policies towards including immigrants within the nation’s health care system. These policies not only reduce immigrants’ access to health care, they add significant complexity to the US health care system, and create a range of health and economic costs to immigrants and natives alike. The chapter focuses in particular on the practice of medical repatriation, whereby hospitals send seriously ill immigrants to their countries of origin, explaining how the conflicting edicts of US health law encourage the practice by requiring hospitals to treat all emergency patients regardless of citizenship or insurance status, while denying many immigrants public benefits for nonemergency care.

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Follow up of Patients with Eagle-Barett (Prune Belly) Syndrome Treated with Single-Stage Abdominoplasty and Total Genitourinary Tract Reconstruction

Revista Urología Colombiana / Colombian Urology Journal ◽

10.1055/s-0039-1688965 ◽

2019 ◽

Vol 29 (01) ◽

pp. 014-020

Author(s):

Nicolás Fernández ◽

Ana María Ortiz ◽

Juan David Iregui ◽

Andrea Estrada ◽

Angeline Rojas ◽

...

Keyword(s):

Renal Function ◽

Urinary Tract ◽

Abdominal Wall ◽

Management Approach ◽

Abdominal Muscles ◽

Prune Belly Syndrome ◽

Urologic Surgery ◽

Prune Belly ◽

Bowel Movements

Abstract Introduction The Prune Belly Syndrome (PBS) is the deficiency or congenital hypoplasia of the abdominal muscles accompanied with disorders of the urinary tract. The surgical treatment for the uropathy of the PBS seeks to correct the anatomical defects that induce damage to the urinary tract, including the improvement of the bladder emptying. The correction of the abdominal wall defect must be considered as an important part of the treatment. Objective To describe of the most relevant clinic characteristics and outcomes of a group of eight patients with PBS managed with abdominoplasty and reconstructive urologic surgery. Methods Retrospective review of the medical charts of patients with PBS at Hospital Universitario San Ignacio, Hospital Militar Central of Bogotá, Clinica Infantil Colsubsidio and Fundación Oftalmológica Ardila Lulle of Bucaramanga, (Colombia) that were managed with reconstructive surgery of the urinary tract and Monfort technique abdominoplasty (between 2006 and 2016) by one of the authors (JPN). The evaluated variables included: phenotypic appearance, renal function, bowel movements, and urinary tract infection (UTI) episodes. These variables as well as the abdominal wall aspect, were evaluated postoperatively. Results There were 11 patients identified with PBS between 2006 and 2016. Eight (8) of them underwent reconstructive urologic surgery, orchidopexy and Monfort technique abdominoplasty. After the procedures, none of the patients presented deterioration of the renal function, and they reported a better quality of the stools according to the Bristol scale; there were also less episodes of UTI. The phenotypic aspect of the abdominal wall was qualified as satisfactory in all cases. Conclusions Reconstructive urologic surgery and abdominoplasty in patients with PBS is an excellent choice of management that reduces the number of UTIs, improves bowel movements according to the Bristol scale, and preserves the renal function. This management approach also improves the phenotypic aspect of the abdominal wall. All of this leads to higher survival rate and better quality of life.

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Health Care Reform and the Health of Performing Artists in the US

Medical Problems of Performing Artists ◽

10.21091/mppa.2009.4031 ◽

2009 ◽

Vol 24 (4) ◽

pp. 155-156

Author(s):

Ralph A Manchester

Keyword(s):

Health Care ◽

Health Insurance ◽

Access To Health Care ◽

Developed Countries ◽

The United States ◽

Performing Artists ◽

Access To Health ◽

The Us ◽

The World ◽

Critical Problems

Health care in the United States is beset by three critical problems: cost, quality, and coverage. We have by far the most expensive health care in the world, spending about 17% of our Gross Domestic Product, or over $7,000/person; most other developed countries spend about 8 to 10% of their GDP on health care.1 Despite spending that much money, the health status of Americans is far from the best in the world, whether one looks at infant mortality,2 life expectancy,3 or survival among people with various diseases. 4 Underlying both problems is the fact that over 15% of the US population does not have health insurance,5 which means they do not have access to health care when it can be delivered most effectively at the lowest cost. While this should be of great concern to anyone who lives in this country, those of us who are invested in the health of performing artists should be especially interested in this issue. For a variety of reasons, performing artists are probably more likely to lack health insurance than is the case for the population at large.

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Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations ◽

10.1044/cds19.3.71 ◽

2012 ◽

Vol 19 (3) ◽

pp. 71-76 ◽

Cited By ~ 1

Author(s):

Pauline A. Mashima

Keyword(s):

Health Care ◽

Health Care Providers ◽

Access To Health Care ◽

Underserved Populations ◽

Linguistically Diverse ◽

Care Providers ◽

Department Of Health ◽

Use Of Technology ◽

Access To Health ◽

Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

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