About as complex as it gets—that’s how pediatric urologist Andrew Freedman, M.D., director of pediatric urology at Cedars-Sinai Medical Center’s Endourology Institute, describes the surgery he performed this summer on then 17- month-old Jalen Brown, born with Prune Belly Syndrome. That surgery required reconstructing the toddler’s urinary system in a nearly 10-hour procedure.
Prune Belly Syndrome, also known as Eagle-Barrett Syndrome, is a very rare occurrence: just one in 80,000 births. An estimated 99 percent of those affected are boys. The cause is still unknown, though some theories suggest urinary tract obstructions and resulting distention or developmental defects in utero.
Like Jalen, most born with Prune Belly Syndrome exhibit three main features: 1) an absence of abdominal muscles, contributing to a “wrinkled” appearance of the skin and a “pot belly” profile, 2) dilated urinary tract and associated problems, and 3) intra-abdominal (undescended) testicles.
These trademark characteristics are typically discovered either prenatally via ultrasound or at birth. Associated medical problems—primarily related to renal function—can be life-threatening. “We weren’t sure he was going to make it,” says Dr. Freedman, citing concerns at birth. For Jalen—and most others with the syndrome—survival depends on medical intervention.
An estimated 20 percent of those affected are stillborn, while another 30 percent die within their first two years. The remaining 50 percent suffer from urinary system disorders of varying severity. Another 10 percent face serious cardiovascular problems such as atrial or septal defects. Musculoskeletal problems afflict 20 percent to 50 percent, including hip dislocation, scoliosis and clubfoot, which Jalen was born with and had surgically corrected.
Jalen’s health issues were diagnosed prenatally when an ultrasound at six months picked up problems. “The ultrasound test was taking so long because they were waiting on the baby to pee,” says Laura, also mom to older sister Jasmine, 6. “The next day I got a call saying I needed to see a perinatalogist. I went through a couple of doctors before the problem was officially diagnosed at Cedars-Sinai, where the urologist said it was probably Prune Belly Syndrome.” When she found out, Laura was actually relieved after worrying about even worse conditions. “There was hope,” she explains.
Jalen’s first surgery, performed by Dr. Freedman when the baby was five days old, was a temporary, initial remedy to his renal problems. The surgeon removed obstructions in the left and right ureters and attached them to the skin just below the rib cage. He spent about a month in the hospital, much of that time under the watchful eye of Neonatal Intensive Care Unit staff.
“Urine would drain into his diapers,” explains mom Laura. “Jalen had to wear big diapers to cover the openings, and we had to change them like clockwork. He couldn’t even have a bath.” But the baby rebounded. Despite prenatal concerns about left kidney function, both of Jalen’s kidneys proved to be working at 100 percent.
In June 2002, Jalen underwent the much-anticipated second phase of surgery, scheduled to coincide with the baby’s growth in size and strength.
“When Jalen was about one, we started looking forward to the surgery—he was healthy enough and it would be time for him to walk soon,” says Laura. And walking he is, following the intricate procedure that required Dr. Freedman to reconstruct and reattach the left ureter to the kidney, join the left and right ureters, and then plug the right into the bladder. At the same time, he performed an abdominoplasty to tighten the abdomen and remove loose skin. He also repositioned the testicles.
“Jalen’s in pretty good shape now,” says Dr. Freedman. “He may never be a sit-up champion, but he’ll be able to ride a bike and play Little League.” And that’s enough for Jalen’s family, who are already seeing the fruits of Dr. Freeman’s labors.
After the surgery, Jalen was able to urinate normally, through his penis, for the first time. “It was a beautiful thing,” says his mother of the experience.
Though Jalen’s prognosis is positive, the extent of kidney damage sustained in utero or as a result of infection is unknown. “We’ll see how many nephrons God gave him,” says Dr. Freedman, alluding to the tiny structures within the kidney that control blood composition and renal function. v For now, Jalen wears a “binder” for support, since he lacks abdominal muscles on the right side. When he’s a teen, Jalen can consider other, cosmetic options. “But that’s his decision,” says his mom. “Right now, we just feel very lucky.”
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern Californias gold standard in health care in an independent survey. It is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
Sandy Van | Cedars-Sinai Public Relations
Hot cars can hit deadly temperatures in as little as one hour
24.05.2018 | Arizona State University
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.
Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...
A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.
The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
25.05.2018 | Event News
02.05.2018 | Event News
13.04.2018 | Event News
25.05.2018 | Event News
25.05.2018 | Machine Engineering
25.05.2018 | Life Sciences