URINARY TRACT MORPHOFUNCTIONAL CHANGES IN PRUNE BELLY SYNDROME: THEORIES AND THE RELATION WITH FETAL PROGNOSIS
KEY WORDS: Prune Belly Syndrome; Urinary Tract/abnormalities; Prognosis
Introduction: Prune Belly Syndrome (PBS) is a congenital disorder of unknown etiology, characterized by a classic triad: urinary tract abnormalities, cryptorchidism and abdominal muscle deficiency. Due to varying degrees of impairment, treatment and prognosis are defined by the clinical individuality of each patient. Method: It was analyzed 18 articles available on differents digital platforms, such as Pubmed, Medline, Scielo, Lilacs, Google Scholar, Capes and BIREME. The analyzed papers were dated from 2005 to 2019 and written in Portuguese, English or Spanish. The articles selection criteria were the following descriptors: Prune Belly Syndrome; Urinary Tract/abnormalities; Prognosis, in addition to the analysis of the references that are applicable. Results: Urinary tract modifications resulting from PBS includes malformations of the kidneys, ureters, bladder and urethra. These alterations vary from microscopic changes, which concern the histological constitution, to macroscopic ones, such as bladder distention. Several theories have been proposed to clarify the etiopathogenesis of this syndrome. Among the most cited, it was highlighted: the obstructive theory that attributes the syndrome origin to a physical blockage of the urethra. This makes the bladder wall hypertrophied, since it requires a greater contraction force to overcome the obstacle, which causes high pressure inside the bladder, with vesico-ureteral reflux and consequent hydronephrosis. Each structural change is closely related to specific etiological theories and may be responsible for several other consequences. Such comorbidities associated with kidney problems do not only concern the fetus survival, but also the quality of life over time. Conclusion: The literature analysis showed that there are still many uncertainties involving the syndrome etiology, which is a major factor for the correct therapeutic approach and determination of fetal prognosis. Therefore, greater academic effort is necessary to clarify the remaining uncertainties about the syndrome.
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