Ventriculo-ureteric shunts, the last resort in complicated shunt patients

Subramaniam, Venugopal; Ganapathy, Sibhi; Paruchuri, Sudheer

doi:10.1016/j.inat.2020.100805

Cited by 5 publications

(9 citation statements)

References 1 publication

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“…Other potential long-term problems in addition to calcifications include biofilm formation on the shunt and erosion of the ureteral wall due to the catheter [12,18]. Percutaneous insertion, with similar techniques as the one we used, has previously been described by Pillai et al and Subramanian et al, where two adults with postinfectious and posttraumatic hydrocephalus were successfully treated [8,12]. To the best of our knowledge, this is the first description of the percutaneous insertion of a VU shunt in a child.…”

Section: Discussionmentioning

confidence: 87%

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Percutaneously inserted ventriculo-ureteral shunt as a salvage treatment in paediatric hydrocephalus: a technical note

et al. 2022

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Background Hydrocephalus is a challenge for paediatric neurosurgeons. When the abdominal cavity and heart fail as diversion sites for cerebrospinal fluid (CSF), many of the otherwise used alternative diversion sites are not feasible due to the smaller physical body size of children and infants. Using the urinary system as a site of diversion has been described in adults primarily. Objective To describe a minimally invasive procedure to percutaneously access the ureter for placement of a distal catheter in the treatment of paediatric hydrocephalus. Methods A percutaneous ultrasound-assisted technique was used to access the renal pelvis for catheter placement into the distal ureter. Results Fifteen months after the surgery, the child has a stable neurological condition and adequately managed hydrocephalus. Conclusion The urinary tract should be considered a viable option for CSF diversion in complex paediatric hydrocephalus. A multidisciplinary approach consisting of interventional radiologists, urologists and neurosurgeons should be involved in the evaluation of potential candidates.

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Section: Discussionmentioning

confidence: 87%

“…3 Tunnelling of the shunt dorsally and connection to the valve distal catheter placement, combined with re-implantation of the ureter, thus avoiding a nephrectomy [7]. The introduction of percutaneous nephrostomy has opened up new possibilities for minimally invasive access to the ureters as a diversion site [8].…”

Section: Discussionmentioning

confidence: 99%

Percutaneously inserted ventriculo-ureteral shunt as a salvage treatment in paediatric hydrocephalus: a technical note

et al. 2022

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“…[6][7][8] Furthermore, CSF diversion into the urinary excretion causes fluid and electrolyte loss in the urine. [9] It is believed homeostatic mechanisms regulating fluid intake are capable of compensating for this loss, [10] but dehydration and electrolyte imbalances can occur, especially when challenged with diarrhea, vomiting or electrolyte abnormalities. [9] Other side effects have been reported, including ureter spasm, encrustation, ureter wall erosion, ascending infection (UTI associated or non), biofilm formation, retrograde urine reflux, catheter migration, failure of urinary diversion, and tube disconnection/migration.…”

Section: Narrative Reviewmentioning

confidence: 99%

“…[9] It is believed homeostatic mechanisms regulating fluid intake are capable of compensating for this loss, [10] but dehydration and electrolyte imbalances can occur, especially when challenged with diarrhea, vomiting or electrolyte abnormalities. [9] Other side effects have been reported, including ureter spasm, encrustation, ureter wall erosion, ascending infection (UTI associated or non), biofilm formation, retrograde urine reflux, catheter migration, failure of urinary diversion, and tube disconnection/migration. [9][10][11][12][13] Furthermore, most neurosurgery training programs do not include training in genitourinary surgery, so assistance from a urologist may be indicated.…”

Section: Narrative Reviewmentioning

confidence: 99%

Ventriculoureteral shunt: Narrative review of contemporary cases and its historical role in the development of renal transplantation

Waack

Hoyt

Schroeder

2023

JNRP

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Ventriculo-ureteral (VU) shunting is a little-known method of managing hydrocephalus. This paper reviews contemporary uses of this shunting technique and describes its historical significance to the field of organ transplantation. The ureter may serve as a possible backup, or alternative, distal drainage site compared to the more common peritoneum, atrium, and pleural space. Sporadic contemporary uses of the VU shunt have been reported in unique situations, demonstrating a possible utility in modern neurosurgery. Interestingly, the VU shunt played an important role in the development of kidney transplantation. In the late 1940s and early 1950s, David Hume, a general surgery resident, and colleagues at the PBBH undertook a series of human kidney transplantations. Concurrently, Donald Matson, a pediatric neurosurgeon at Peter Bent Brigham, was utilizing the VU shunt in hydrocephalic patients. Dr. Matson’s VU shunt technique involved total nephrectomy, and some of the kidneys harvested from Dr. Matson’s were used by his general surgery colleagues in their transplantation trials. Although none of the transplanted kidneys from this series were successful, the transplant team in Boston, minus David Hume, went on to perform the world’s first kidney transplant a few years later. This relatively unfamiliar procedure may be applicable to specific situations, and it is of historical importance to the field of transplantation.

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“…Nearly 30% of ventriculoperitoneal shunts fail within the first year, requiring revision [4]. Reasons for VPS revision include infection, migration, over-drainage, fracture, and obstruction [5][6][7]. Given the high complication rates and need for revision, multiple sites for distal cerebrospinal fluid (CSF) diversion has been described when the peritoneum is no longer suitable for catheter placement including placement in the pleura, gallbladder, ureter, fallopian tube, and atrium of the heart [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Open Retroperitoneal Inferior Vena Cava Cannulation for Distal Ventriculoatrial Shunt Catheter Placement

Mustroph¹,

Saberian²,

Burch³

et al. 2022

Cureus

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Multiple alternative sites for distal ventriculoperitoneal shunts have been described including pleural, atrial, ureteral, fallopian, and gallbladder placement. In medically complex patients the sites for cerebrospinal fluid (CSF) diversion can be exhausted. We present a case where open retroperitoneal inferior vena cava cannulation was used for successful atrial catheter placement in a 17-month-old female. The patient had a complex abdominal, pulmonary, and vascular history precluding placement of the distal catheter in other sites or atrial placement through more peripheral venous cannulation. The patient underwent uncomplicated open retroperitoneal exposure of her inferior vena cava (IVC) with cannulation and placement of atrial catheter under fluoroscopic guidance. At the follow-up one year after surgery, the patient did not require revision with appropriate placement of the distal atrial catheter.

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Ventriculo-ureteric shunts, the last resort in complicated shunt patients

Cited by 5 publications

References 1 publication

Percutaneously inserted ventriculo-ureteral shunt as a salvage treatment in paediatric hydrocephalus: a technical note

Percutaneously inserted ventriculo-ureteral shunt as a salvage treatment in paediatric hydrocephalus: a technical note

Ventriculoureteral shunt: Narrative review of contemporary cases and its historical role in the development of renal transplantation

Open Retroperitoneal Inferior Vena Cava Cannulation for Distal Ventriculoatrial Shunt Catheter Placement

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