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Shunt infection and malfunction after augmentation cystoplasty
E B Yerkes1, R C Rink, M P Cain
1Division of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
The Journal of Urology
|May 24, 2001
Summary
Bladder augmentation in patients with ventriculoperitoneal shunts is safe, with a low infection rate (<2%). Distal shunt revision rates are comparable to those without prior urological surgery.
Area of Science:
- Urology
- Neurosurgery
- Pediatric Surgery
Background:
- Maintaining a sterile intraperitoneal environment is crucial for patients with ventriculoperitoneal shunts.
- Augmentation cystoplasty for neuropathic bladder can impact shunt integrity.
- Discrepancies exist in reported shunt infection rates after augmentation cystoplasty.
Purpose of the Study:
- To determine the incidence of shunt infection and revision after augmentation cystoplasty in patients with myelodysplasia and ventriculoperitoneal shunts.
- To define the need for distal shunt revision in this patient population.
Main Methods:
- Retrospective review of patients with myelodysplasia and ventriculoperitoneal shunts undergoing augmentation cystoplasty since August 1990.
- Minimum 12-month postoperative follow-up.
- Standardized perioperative and intraoperative protocols including antibiotics and shunt isolation.
Main Results:
- 55 patients with myelodysplasia and ventriculoperitoneal shunts underwent augmentation cystoplasty.
- Mean follow-up was 60.4 months.
- Shunt infection occurred in one patient (<2%). Distal shunt revision was required in 5 patients (9%) for obstruction, including one cerebrospinal fluid pseudocyst. Bladder perforation occurred in 2 patients.
Conclusions:
- Augmentation cystoplasty can be safely performed in patients with ventriculoperitoneal shunts, with a low incidence of shunt infection.
- Meticulous perioperative and intraoperative preparation is key to minimizing adverse events.
- The rate of distal shunt revision is significant but comparable to the general failure rate of ventriculoperitoneal shunts.