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Obaidy Y, Sherzad A, Moghul D. Urethral migration of a ventriculoperitoneal shunt in a 6-month-Old female infant: A rare complication of hydrocephalus management. Urol Case Rep 2025; 60:102998. [PMID: 40161875 PMCID: PMC11953984 DOI: 10.1016/j.eucr.2025.102998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Accepted: 03/01/2025] [Indexed: 04/02/2025] Open
Abstract
Hydrocephalus, occurring in 0.9-1.8 per 1000 births, is managed through ventriculoperitoneal shunt placement. This intervention carries potential complications, with migration and infection being predominant concerns. 6-month-old female infant presented with VP shunt migration through the urethra, 5 months after hydrocephalus treatment. Clinical manifestations included irritability, mild fever, vomiting, and tense, bulging fontanelle. Laboratory findings revealed elevated white blood cell count of 21,000/mm3 and positive microbiological cultures. Surgical intervention involved catheter removal, and shunt revision. This rare case of VP shunt urethral migration highlights the critical importance of vigilant monitoring and prompt, multidisciplinary intervention in pediatric neurosurgery.
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Affiliation(s)
- Yalda Obaidy
- Department of Surgery, Ataturk Hospital, Kabul, Afghanistan
| | - Ajmal Sherzad
- Department of Surgery, Ataturk Hospital, Kabul, Afghanistan
| | - Dunya Moghul
- McGill University Faculty of Medicine and Health Sciences, Montreal, QC, Canada
- Harvey E. Beardmore Department of Surgery, Montreal Children's Hospital, Montreal, QC, Canada
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Allos H, Hasbun R. Current understanding of infection of the ventricles and its complications. Expert Rev Anti Infect Ther 2024; 22:1023-1042. [PMID: 39163406 DOI: 10.1080/14787210.2024.2395018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/18/2024] [Indexed: 08/22/2024]
Abstract
INTRODUCTION Ventriculitis, characterized by inflammation of the ventricles in the brain, frequently occurs as a complication of neurosurgical interventions such as the insertion of cerebrospinal fluid (CSF) shunts or external ventricular drains. It can also present as a community-acquired pathology, broadening its clinical significance and complicating diagnosis and treatment. This condition presents significant challenges, primarily due to its association with various medical devices and the predisposing conditions of patients which enhance infection risks. AREAS COVERED The review comprehensively explores the etiology, risk factors, diagnostic methodologies, and treatment options for ventriculitis. A thorough literature search was conducted, focusing on recent studies, meta-analyses, and clinical reports that discuss the incidence rates, the effectiveness of different management strategies, and the impact of device-related and community-acquired infections. Particular attention is given to the role of CSF drains and shunts, biofilms, and the prophylactic measures employed in clinical settings to mitigate infection risks. EXPERT OPINION Despite advances in medical technology and infection control protocols, ventriculitis remains a severe complication in both neurosurgical and community settings. The review highlights the need for continued research into innovative diagnostic tools and more effective infection control strategies.
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Affiliation(s)
- Hazim Allos
- Department of Medicine, Section of Infectious Disease, McGovern Medical School, UTHealth Science Center, Houston, TX, USA
| | - Rodrigo Hasbun
- Department of Medicine, Section of Infectious Disease, McGovern Medical School, UTHealth Science Center, Houston, TX, USA
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Caglar O, Kanat A, Aydin MD, Akca N, Ozmen S. First report of the histopathological effect of electrocautery using on the urethral taste rosea during glans penis injury by incision in rabbits. Asian J Urol 2024; 11:115-120. [PMID: 38312826 PMCID: PMC10837657 DOI: 10.1016/j.ajur.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/04/2021] [Indexed: 10/18/2022] Open
Abstract
Objective Currently, electrocautery devices have frequently been used in penile surgical procedures. We hypothesized that electrocautery using during penile surgical procedures may harm the taste rosea and the dorsal nerve of the penis or clitoris. Methods Eighteen young age male New Zealand rabbits were studied: five in the control (Group I, n=5), five in the penile surgery without using electrocautery (sham group, Group II, n=5), eight in the monopolar cautery (study group, Group III, n=8) groups under general anesthesia. The animals were followed for 3 weeks and sacrificed. Penile tissue-pudendal nerve root complexes and dorsal root ganglion of sacral 3 level were examined using stereological methods. The results were compared statistically. Results The live and degenerated taste bud-like structures and degenerated neuron densities of pudendal ganglia (mean±standard deviation, n/mm3) were estimated as 198±24/mm3, 4±1/mm3, and 5±1/mm3 in Group I; 8±3/mm3, 174±21/mm3, and 24±7/mm3 in Group II; and 21±5/mm3, 137±14/mm3, and 95±12/mm3 in Group III, respectively. Neurodegeneration of taste buds and pudendal ganglia was significantly different between groups. Conclusion Intact spinal cord and normal parasympathetic and thoracolumbar sympathetic networks are crucial for human sexual function. The present study indicates that the glans penis injury by using electrocautery may lead to pudendal ganglia degeneration. Iatrogenic damage to taste rosea and retrograde degeneration of the pudendal nerve may be the cause of sexual dysfunction responsible mechanism.
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Affiliation(s)
- Ozgur Caglar
- Ataturk University, Medical Faculty, Department of Pediatric Surgery, Erzurum, Turkey
| | - Ayhan Kanat
- Recep Tayyip Erdogan University, Medical Faculty, Department of Neurosurgery, Rize, Turkey
| | - Mehmet Dumlu Aydin
- Ataturk University, Medical Faculty, Department of Neurosurgery, Erzurum, Turkey
| | - Nezih Akca
- Recep Tayyip Erdogan University, Medical Faculty, Department of Urology, Rize, Turkey
| | - Sevilay Ozmen
- Ataturk University, Medical Faculty, Department of Pathology, Erzurum, Turkey
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Guvercin AR, Besir A, Kanat A, Yazar U, Findik H. Interesting negative correlation between transorbital optic nerve sheath diameter and Evans' index values; can it be predictive for failure of endoscopic third ventriculostomy? Int J Neurosci 2022:1-7. [PMID: 36120999 DOI: 10.1080/00207454.2022.2126775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Currently, Endoscopic third ventriculostomy (ETV) is one of the commonly used surgical options for the treatment of non-communicating hydrocephalus but reported success rates from ETV vary considerably, and a reliable noninvasive means to detect the efficacy of ETV is still lacking. In this study, the changes in Evans's Index and the transorbital optic nerve sheath (ONSD) diameter measurement after endoscopic third ventriculostomy were compared. Methods: Preoperative and early postoperative ultrasonographic ONSD measurement and preoperative and postoperative 3 months Evans' index of patients with hydrocephalus on whom ETVs were performed between 1 February 2018 and 23 May 2022 and analyzed. Results: The chart of 8 male and 2 female patients was analyzed. Their median age at presentation was 5.3 years (range 1 - 14 years). Mean ONSD values were 5.66 mms in the preoperative period, which was decreased to a mean of 4.17 mms in the early postoperative period. The Evans' index was 0.5320 in the preoperative period; however, it decreased to 0.4460 in the postoperative 3rd months. The preoperative and early postoperative mean ONSD values and Evans' Index of patients were significantly different. Interestingly, a negative correlation was also observed between ONSD values and Evans' index. Conclusions: ONSD measurement and Evans' index have been commonly used after ETV procedures İn pediatric patients with hydrocephalus. Still, there is an unexplained negative correlation between ONSD and Evans' index values. This study indicates that the two measures (Evans's index and ONSD) should be considered when performing follow-up examinations in patients after ETV.
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Affiliation(s)
- Ali Rıza Guvercin
- Medical Faculty, Department of Neurosurgery, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Besir
- Medical Faculty, Department of Anesthesiology and Critical Care. Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ayhan Kanat
- Medical Faculty, Department of Neurosurgery, Recep Tayyip Erdogan University, Rize Merkez, Turkey
| | - Ugur Yazar
- Medical Faculty, Department of Neurosurgery, Karadeniz Technical University, Trabzon, Turkey
| | - Huseyin Findik
- Department of Ophthalmology, Recep Tayyip Erdogan University Medical Faculty, Rize Merkez, Turkey
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Guimarães AS, Vaz Júnior M, Martins SP, Fagundes-Pereyra WJ. Rare case of migration and perforation of the urinary bladder by ventriculoperitoneal shunt catheter with intravesical knotted formation: A case report and literature review. Surg Neurol Int 2022; 13:75. [PMID: 35399874 PMCID: PMC8986715 DOI: 10.25259/sni_804_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The most commonly used technique in the management of hydrocephalus is a neurosurgical procedure, known as ventriculoperitoneal shunt (VPS). Several complications of the distal end of a VPS catheter have been described in the literature, although migration and erosive bladder perforation of this shunt are extremely uncommon. Case Description: We relate a rare pediatric case of a 4-year-old boy, with long-term dysuria, intermittent incontinence, and chronic abdominal pain developed during a myelomeningocele postoperative period, without other symptoms. A bladder fistula with the distal end of the VPS inside the bladder was observed while performing an ultrasound to investigate the urinary tract. Two months before the current surgical approach, the patient, with hydrocephalus and alterations compatible with Chiari malformation, was treated with VPS and subsequently subjected to the third ventriculostomy. The child was unsuccessfully treated with an infraumbilical laparotomy, with section and careful traction of the catheter. A vesicostomy was then performed and the catheter was observed to form an intravesical knot. Conclusion: The intravesical knot formation is extremely rare and its mechanism of formation is still not well understood. Patients with VPS need adequate medical follow-up to identify possible complications of the shunt.
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Affiliation(s)
- Amanda Silva Guimarães
- Department of Neurosurgery, Health Sciences Center, Federal University of Espírito Santo, Brazil
| | - Mário Vaz Júnior
- Department of Pediatric Surgery, Hospital Infantil Nossa Senhora da Glória, Vitória, Espírito Santo, Brazil
| | - Samuel Paiva Martins
- Department of Pediatric Surgery, Hospital Infantil Nossa Senhora da Glória, Vitória, Espírito Santo, Brazil
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Fauzi AA, Parenrengi MA, Wahyuhadi J, Subagio EA, Turchan A. Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v55i4.24515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.
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Anjankar SD. Urethral Protrusion of the Distal End of Shunt. J Pediatr Neurosci 2018; 13:371-372. [PMID: 30271479 PMCID: PMC6144611 DOI: 10.4103/jpn.jpn_54_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shailendra D. Anjankar
- Assistant Professor, Department of Neurosurgery, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India,Address for correspondence: Dr. Shailendra Anjankar, S.D. Hospital, Plot no. 50, Ganesh Nagar, Great Nag Road, Nagpur, Maharashtra 440024, India. E-mail:
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Osman B, Roushias S, Hargest R, Narahari K. Migration of ventriculoperitoneal shunt to urethral and rectal orifices. BMJ Case Rep 2017; 2017:bcr-2017-220187. [PMID: 29122895 DOI: 10.1136/bcr-2017-220187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Ventriculoperitoneal (VP) shunt surgery remains the most widely used neurosurgical procedure for the management of hydrocephalus. However, shunt complications are common and may require multiple surgical procedures during a patient's lifetime. We report the case of a 29-year-old patient with a background of Dandy-Walker malformation, occipital encephalocele, recurrent hydrocephalus, spina bifida and epilepsy presented with VP shunt migration into urinary and gastrointestinal tracts. In absence of sepsis or peritonism from either bowel or bladder perforation, local control of stent extrusion was successful for several years, although surgery was eventually undertaken.
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Affiliation(s)
- Banan Osman
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
| | - Stella Roushias
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
| | | | - Krishna Narahari
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
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Liu Y, Li C, Tian Y. Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-016-0064-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Al Fauzi A, Djatisoesanto W, Wahyuhadi J, Parenrengi MA, Turchan A. A Rare Case of Repeated Migration and Transurethral Extrusion of Ventriculoperitoneal Shunt. J Pediatr Neurosci 2017; 12:96-98. [PMID: 28553396 PMCID: PMC5437805 DOI: 10.4103/jpn.jpn_189_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Wahjoe Djatisoesanto
- Department of Urology, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
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Abstract
BACKGROUND Bladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature. CASE DESCRIPTION This work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra. DISCUSSION AND CONCLUSION Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.
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A novel clinical observation in neuroleptic malignant-like syndrome: first demonstration of early progression of hydrocephalus. J Clin Psychopharmacol 2015; 35:211-2. [PMID: 25679124 DOI: 10.1097/jcp.0000000000000293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mutlu M, Kader Ş, Aslan Y, Yazar U, İmamoğlu M. An Acute Complication of Ventriculoperitoneal Shunt with Bladder Perforation and Extrusion through the Urethra in a Newborn: Case Report and Review of the Literature. Pediatr Neurosurg 2015; 50:264-9. [PMID: 26159187 DOI: 10.1159/000433604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/27/2015] [Indexed: 11/19/2022]
Abstract
Ventriculoperitoneal shunt (VPS) surgery is a standard procedure for the management of hydrocephalus. Bladder perforation is an extremely rare complication of VPS surgery. Herein, we present for the first time an acute complication of VPS with bladder perforation and extrusion through the urethra in a newborn. We also reviewed the complication of VPS with bladder perforation as reported in the literature.
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Post-traumatic fractured ventriculo-peritoneal shunt presenting as shunt failure. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Herniation of Meckel's diverticulum into a ventriculoperitoneal shunt tract. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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