Pediatric Urology Modified Abdominoplasty for Patients With the Prune Belly Syndrome Francisco Tibor D enes, Roberto Iglesias Lopes, Lorena Marc ¸alo Oliveira, Alessandro Tavares, and Miguel Srougi OBJECTIVE To present the results of a new technique for abdominoplasty in patients with the Prune Belly syndrome (PBS). METHODS Since 1985, 46 children with PBS underwent surgical treatment that included urinary tract reconstruction (UTR), orchidopexy, and abdominoplasty. In 41 patients, we performed the abdominoplasty as follows: (1) fusiform longitudinal resection of the mid-abdominal skin and subcutaneous tissue, with preservation of the musculo-aponeurotic fascia (MAF) and umbilicus, (2) ellipsoid unilateral longitudinal incision of the MAF in the most weakened side of the abdomen, producing 2 flaps, with the umbilicus being kept intact in the widest flap, (3) after UTR and bilateral orchiopexy, suture fixation of the widest MAF layer to the inner side of the contralateral abdominal wall, creating an inner MAF layer, (4) lateral suture fixation of the other flap over the inner layer, creating an outer MAF layer with a buttonhole exposing the umbilicus, that is sutured to the outer layer, and (5) approximation of the skin edges with incorporation of the umbilicus in the suture. RESULTS Skin coaptation was excellent in all patients, and no trimming was necessary in incision extremities. There was no dehiscence or skin necrosis and all patients presented immediate improvement of the abdominal tonus and appearance. Further improvement with growth was observed in all except 4 patients, 2 requiring secondary abdominoplasties. CONCLUSION We conclude that this technique is applicable in all forms of weakened abdomen typical of PBS, even in asymmetrical cases, requiring only 1 MAF incision, with good cosmetic and functional results. UROLOGY 83: 451e454, 2014. Ó 2014 Elsevier Inc. P rune belly syndrome (PBS) is an uncommon anomaly with an incidence of 1:35,000 to 1:50,000 live births. Described by Frolich in 1839, it occurs almost exclusively in boys, presenting 3 main features: abdominal wall flaccidity with partial or complete absence of the muscular layers, bilateral intra- abdominal cryptorchidism, and variable urologic abnor- malities characterized mainly by hydroureteronephrosis and vesico-ureteric reflux. 1-3 Besides the characteristic prune-like aspect of the skin, the abdominal flaccidity diminishes the support and compression of the intra-abdominal viscera, facilitating lordosis, constipation, and increased bladder residuals. It also decreases the movements of the trunk as well as the ability to cough and expectorate, facilitating respiratory infections. 1,2 In addition to functional impairment, the poor cosmetic appearance is associated with psychosocial consequences. 1,2 Several techniques have been described for recon- struction of the abdominal wall in these patients. 4-14 The surgical technique presented in this article has the purpose to improve strength, esthetics, and function of the abdominal wall. This experience with abdominal reconstruction is, to our knowledge, the largest reported in the literature. PATIENTS AND METHODS From 1985 to 2013, 46 patients with PBS underwent abdominal reconstruction in our institution with a modified technique for the abdominal repair in 41 children. Mean age at presentation was 1.2 years (range 1 month to 10 years) and mean follow-up was 139 months (range 6 months to 26 years). A retrospective chart review was performed assessing functional and esthetic results of this new and simplified abdominal repair. The technique consists of the following steps: (1) with the patient in the supine position under general anesthesia (Fig. 1A), a longitudinal xypho-pubic ellipsoid figure is drawn on the anterior abdomen of the patient. The drawings are individually made according to abdominal flaccidity and redundancy that are grossly calculated by the approximation of the redundant skin to the midline (Fig. 1B). As the abdominal wall defect is usually asymmetrical, the excised skin area can be more convex (lopsided) to the most flaccid side (Fig. 1C). Financial Disclosure: The authors declare that they have no relevant financial interests. From the Division of Urology, University of São Paulo Medical School, São Paulo, Brazil Reprint requests: Francisco Tibor D enes, Ph.D., Division of Urology, University of São Paulo Medical School, Rua Dr.  Eneas de Carvalho Aguiar, 455-7 andar, São Paulo, Brazil. E-mail: ftdenes@gmail.com Submitted: August 5, 2013, accepted (with revisions): September 27, 2013 ª 2014 Elsevier Inc. 0090-4295/14/$36.00 451 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2013.09.031