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• W1976230308 abstract "No AccessJournal of UrologyAugmentation1 Jun 2001SHUNT INFECTION AND MALFUNCTION AFTER AUGMENTATION CYSTOPLASTY ELIZABETH B. YERKES, RICHARD C. RINK, MARK P. CAIN, THOMAS G. LUERSSEN, and ANTHONY J. CASALE ELIZABETH B. YERKESELIZABETH B. YERKES More articles by this author , RICHARD C. RINKRICHARD C. RINK More articles by this author , MARK P. CAINMARK P. CAIN More articles by this author , THOMAS G. LUERSSENTHOMAS G. LUERSSEN More articles by this author , and ANTHONY J. CASALEANTHONY J. CASALE More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66180-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract 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. References 1 : Cerebrospinal fluid shunt infections. In: Central Nervous System Infectious Disease and Therapy. Edited by . New York: Dekker1997: 519. chapt. 25. Google Scholar 2 : Commentary on VP shunt infection after abdominal operations. J Pediatr Surg1992; 27: 1053. Google Scholar 3 : Augmentation cystoplasty complicated by postoperative ventriculoperitoneal shunt infection. J Urol1990; 144: 955. Link, Google Scholar 4 : Ventriculoperitoneal shunt infection after augmentation cystoplasty. J Urol1996; 155: 686. Link, Google Scholar 5 : Ventriculoperitoneal shunt infection after bladder augmentation. Urology1999; 54: 356. Google Scholar 6 : A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg1993; 19: 233. Google Scholar 7 : The risk of abdominal operations in children with ventriculoperitoneal shunts. J Pediatr Surg1992; 27: 1051. Google Scholar 8 : Re: Augmentation cystoplasty complicated by postoperative ventriculoperitoneal shunt infection. (letter to the editor). J Urol1992; 147: 171. Link, Google Scholar 9 : Shunt obstruction: a preventable complication?. Pediatr Neurosurg1993; 19: 156. Google Scholar 10 : Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types. Acta Neurochir1995; 136: 189. Google Scholar 11 : Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst1996; 12: 748. Google Scholar 12 : Time-related patterns of ventricular shunt failure. Childs Nerv Syst1994; 10: 524. Google Scholar 13 : Abdominal cerebrospinal fluid pseudocysts. Childs Nerv Syst1996; 12: 755. Google Scholar 14 : Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in children. Pediatr Neurosurg1998; 29: 267. Google Scholar 15 : Abdominal cerebrospinal fluid pseudocyst: occurrence after intraperitoneal urological surgery in children with ventriculoperitoneal shunts. J Urol1991; 146: 583. Link, Google Scholar From the Divisions of Pediatric Urology and Pediatric Neurosurgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByCasperson K, Fronczak C, Siparsky G, O'Donnell C, Gundeti M, Campbell J and Wilcox D (2011) Ventriculoperitoneal Shunt Infections After Bladder Surgery: is Mechanical Bowel Preparation Necessary?Journal of Urology, VOL. 186, NO. 4S, (1571-1575), Online publication date: 1-Oct-2011.Barker G, Läckgren G, Stenberg A and Arnell K (2018) Distal Shunt Obstruction in Children With Myelomeningocele After Bladder PerforationJournal of Urology, VOL. 176, NO. 4S, (1726-1728), Online publication date: 1-Oct-2006.Gundeti M, Godbole P and Wilcox D (2018) Is Bowel Preparation Required Before Cystoplasty in Children?Journal of Urology, VOL. 176, NO. 4, (1574-1577), Online publication date: 1-Oct-2006. Volume 165Issue 6 Part 2June 2001Page: 2262-2264 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsbladderventriculoperitoneal shuntmeningomyeloceleMetricsAuthor Information ELIZABETH B. YERKES More articles by this author RICHARD C. RINK More articles by this author MARK P. CAIN More articles by this author THOMAS G. LUERSSEN More articles by this author ANTHONY J. CASALE More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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