WOFAPS 2025 8th World Congress of Pediatric Surgery

Hammou Benslimane, Fatema Hadjou Belaid

faculté de médecine d'Oran Algérie

Purpose: To describe the clinical presentation, surgical technique, treatment outcomes, and to provide a review of the literature.

Materials and Methods: A newborn, 2 days old, was admitted for urinary retention. Clinical examination showed a moderately altered general condition, a massively distended abdomen with a lax abdominal wall, and on palpation, two enlarged kidneys. The penis was wide, swollen, deviated downward, with exaggerated curvature during erection, an apical urethral meatus, dribbling urination, penile swelling during urination, and bilateral undescended testes.

Main Results: Laboratory tests revealed impaired renal function. Urine culture was positive for E. coli.Ultrasound showed bilateral ureterohydronephrosis with significant thinning of the renal parenchyma, more pronounced on the right.Initial management included antibiotic therapy for the urinary tract infection and bilateral pyelostomy to improve renal function, along with abdominal bandaging.Further investigations included a voiding cystourethrogram, which revealed high-grade bilateral vesicoureteral reflux, and renal scintigraphy showed a non-functioning right kidney.Secondary treatment of the megaurethra was performed at 3 months of age by urethroplasty using the Nesbitt technique. Postoperative outcomes were favorable.

Conclusions: The combination of prune belly syndrome with megaphallic presentation is rare but recognized. The prognosis depends largely on the extent of renal impairment. Management is complex and aims to preserve both renal and bladder function, while achieving good cosmetic and functional outcomes for the penis and abdominal wall.