Shunt conversion before bladder augmentation can prevent shunt infection

We report our experience of shunt infections (SIs) following intestinal cystoplasty (CP) in patients with neurogenic bladder (NB) and hydrocephalus.

We reviewed 34 patients with NB who underwent intestinal CP between 1984 and 2005. All had ventriculoperitoneal (VP) shunts converted to ventriculopleural (VL) shunts prior to intestinal CP to prevent SIs. SI secondary to intestinal CP was defined as infection within 30 days of intestinal CP.

No SIs were reported. Mean age at shunt conversion was 9.5 years (range, 2-25 years), mean length of follow-up after conversion was 12.8 years (range, 2-18 years), and mean period between conversion and CP was 12 days (range, 0-30 days). Pleural effusion (PE) occurred post-conversion in 13/34 subjects (41%). Ten were treated with diuretics for a mean of 12 days, two were treated conservatively, and one required revision to a ventriculoatrial shunt. Delayed PE occurred in two patients at 7 and 18 months, secondary to respiratory infections. In the literature, there are six reports of SIs after intestinal CP in 216 NB patients. Overall, seven of 216 patients (3.2%) had SI.

VP shunts should be converted to VL shunts prior to intestinal CP because this appears to prevent SIs.