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Ventriculoperitoneal shunt infection after augmentation cystoplasty
G J Matthews1, B A Churchill, G A McLorie
1Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Ventriculoperitoneal shunt infections are common after bladder augmentation in children with myelodysplasia. Early infections were gram-positive, while delayed infections were gram-negative, suggesting a need for urinary tract sterilization before surgery.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Infectious Diseases
Background:
- Augmentation cystoplasty is a surgical procedure to increase bladder capacity.
- Ventriculoperitoneal shunts are often necessary in children with myelodysplasia to manage hydrocephalus.
- Shunt infections are a significant complication in neurosurgery.
Purpose of the Study:
- To characterize the incidence and patterns of ventriculoperitoneal shunt infections following augmentation cystoplasty in children with myelodysplasia.
Main Methods:
- Retrospective review of medical records for 20 children with myelodysplasia and ventriculoperitoneal shunts.
- Minimum follow-up period of 12 months post-augmentation surgery.
- Analysis of infection timing, causative organisms, and relation to preoperative urine cultures.
Main Results:
- A 20% incidence of ventriculoperitoneal shunt infection was observed (4 out of 20 children).
- The single gram-positive infection presented early (within 30 days).
- Three gram-negative infections presented later (over 30 days), with organisms identified in preoperative urine cultures in two cases.
Conclusions:
- Ventriculoperitoneal shunt infection is a frequent complication after augmentation cystoplasty in this patient population.
- Delayed shunt infections may suggest a gram-negative etiology.
- Preoperative sterilization of the urinary tract is recommended to reduce infection risk.
Purpose:
We characterized the occurrence of ventriculoperitoneal shunt infections after augmentation cystoplasty.
Materials And Methods:
We reviewed the records of 20 myelodysplastic children with ventriculoperitoneal shunts followed for a minimum of 12 months after augmentation.
Results:
In 4 children (20%) a ventriculoperitoneal shunt infection developed. The single gram-positive infection occurred early (less than 30 days). The 3 gram-negative infections were delayed presentations (greater than 30 days). Organisms in 2 of the 3 gram-negative infections had been noted in a preoperative urine culture.
Conclusions:
Ventriculoperitoneal shunt infection after bladder augmentation is common. Delayed presentation of shunt infections may indicate gram-negative infection. Sterilization of the urinary tract is indicated before augmentation.