Cerebrospinal Fluid Shunt Complications after Urological Procedures in Children with Myelodysplasia

ABSTRACT OBJECTIVE Invasive urological procedures, commonly performed on patients with myelodysplasia, may contribute to the occurrence of cerebrospinal fluid shunt complications. Shunt complications that occurred after urological procedures in children with myelodysplasia were studied. METHODS Shunt complications occurring after urological procedures were examined in 29 patients. Differences between patients with or without complications were studied. Complications were analyzed according to the location of abnormality, the treatment, and the timing after shunt and urological surgery. RESULTS The 1-year incidence of shunt complications after a urological procedure had been performed was 31% (overall incidence, 41.4%). Shunt complications were observed only after intraperitoneal urological procedures. Most complications were distal, occurring more than 1 year after the preceding shunt surgery. The patients in the shunt complications group had significantly more intraperitoneal urological procedures (3.2 versus 0.8, P = 0.004) and previous shunt revisions (2.0 versus 0.9, P = 0.015) than had the group without complications. As compared with the group of patients with extraperitoneal complications, the intraperitoneal group experienced significantly more infections (4 of 9 versus 0 of 10, P = 0.014) requiring more complex treatment, and their complications occurred significantly earlier in the follow-up period after the urological procedure had been performed (7.2 versus 27.3 mo, P = 0.006). The patients in the group with extraperitoneal complications experienced significantly more mechanical shunt malfunctions than did the intraperitoneal group (9 of 10 versus 4 of 9, P = 0.016), which required simple shunt revisions. CONCLUSION Patients with spina bifida and shunted hydrocephalus may have an increased risk of developing intraperitoneal shunt complications after intraperitoneal urological procedures have been performed. These intraperitoneal shunt complications usually occur a few months after urological surgery and require complex treatment.