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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.
Purpose:
Maintenance of a sterile intraperitoneal environment is critical in patients with ventriculoperitoneal shunts. Recent series have reported a broad discrepancy in the rate of shunt infection (0% to 20%) following augmentation cystoplasty. The need for distal shunt revision has not been well defined. We report the incidence of shunt infection and revision at our institution after bladder augmentation.
Materials And Methods:
We retrospectively reviewed the records of all patients with myelodysplasia and a ventriculoperitoneal shunt who underwent augmentation cystoplasty since August 1990. All patients included in the study had a minimum of 12 months of followup.
Results:
A total of 55 patients with a ventriculoperitoneal shunt secondary to myelodysplasia required augmentation cystoplasty for management of a neuropathic bladder. Standard perioperative intravenous and oral antibiotic preparation, mechanical bowel preparation and intraoperative shunt isolation were used. Mean postoperative followup was 60.4 months (range 12 to 111). One patient presented with an extruded peritoneal shunt tip and positive cultures from cerebrospinal fluid and urine. Bladder perforation occurred in 2 patients and the shunt was empirically externalized. Revision was required for 5 (9%) distal shunt obstructions, including 1 cerebrospinal fluid pseudocyst.
Conclusions:
The incidence of shunt infection after augmentation cystoplasty is low (less than 2% in this large series), and presence of a ventriculoperitoneal shunt should not preclude bladder augmentation. Meticulous perioperative and intraoperative preparation contributes to the low rate of adverse events. Although the rate of distal revision after augmentation is significant, it does not exceed the reported distal failure rate for ventriculoperitoneal shunts in children without a history of urological surgery.
Insights
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.