title: Shunt conversion before bladder augmentation can prevent shunt infection.
abstract: OBJECTIVE
  We report our experience of shunt infections (SIs) following intestinal cystoplasty (CP) in patients with neurogenic bladder (NB) and hydrocephalus.
  
  
  METHODS
  We reviewed 34 patients with NB who underwent intestinal CP between 1984 and 2005. All had ventriculoperitoneal (VP) shunts converted to ventriculopleural (VL) shunts prior to intestinal CP to prevent SIs. SI secondary to intestinal CP was defined as infection within 30 days of intestinal CP.
  
  
  RESULTS
  No SIs were reported. Mean age at shunt conversion was 9.5 years (range, 2-25 years), mean length of follow-up after conversion was 12.8 years (range, 2-18 years), and mean period between conversion and CP was 12 days (range, 0-30 days). Pleural effusion (PE) occurred post-conversion in 13/34 subjects (41%). Ten were treated with diuretics for a mean of 12 days, two were treated conservatively, and one required revision to a ventriculoatrial shunt. Delayed PE occurred in two patients at 7 and 18 months, secondary to respiratory infections. In the literature, there are six reports of SIs after intestinal CP in 216 NB patients. Overall, seven of 216 patients (3.2%) had SI.
  
  
  CONCLUSIONS
  VP shunts should be converted to VL shunts prior to intestinal CP because this appears to prevent SIs.
authors.affiliation: Department of Paediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D017053:Infection Control / Q000379:methods*; D007422:Intestines / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*