title: Prevention of ventriculoperitoneal shunt complications after intraperitoneal urological surgeries.
abstract: OBJECTIVE
  To evaluate perioperative management for the prevention of postoperative shunt infection and malfunction after intraperitoneal urological surgery in patients with myelodysplasia and a ventriculoperitoneal shunt.
  
  
  METHODS
  From 2005 to 2015, 20 consecutive patients with myelodysplasia and a ventriculoperitoneal shunt who underwent intraperitoneal urological surgeries were managed with the same perioperative regimen. Intraperitoneal surgeries involved opening gastrointestinal tracts, including bladder augmentation by enterocystoplasty, creating continent catheterizable channels and Malone antegrade continent enema. We compared results with those from seven previous reports regarding postoperative shunt complications, surgical histories of previous shunt revisions, management of bacteriuria before surgery preoperative bowel preparation, antibiotic regimens, and duration of indwelling drain.
  
  
  RESULTS
  Of 20 patients, 18 received prior shunt revisions, and 14 had positive urine culture before surgery that was managed with oral antibiotics. Thirteen patients underwent bladder augmentation with ileum, and one underwent augmentation with sigmoid colon. Nineteen patients underwent Malone antegrade continent enema using the appendix. All parenteral antibiotics were stopped on postoperative day 2.5. Mean duration of indwelling peritoneal drain was 2.7days. Mean follow-up period was 59.8months. Neither postoperative shunt infections nor intraperitoneal shunt malfunctions were recognized during follow-up period.
  
  
  CONCLUSIONS
  This is the first study to evaluate postoperative ventriculoperitoneal shunt complications in patients with myelodysplasia who underwent intraperitoneal urological surgeries with a specific perioperative regimen. Shunt complications are greatly reduced by rigorous perioperative management, including preoperative control of bacteriuria, appropriate administration of prophylactic antibiotics, and early removal of intraperitoneal drains.
  
  
  METHODS
  The type of study: Case series with no comparison group, IV.
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Akiyama
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kanagawa Children's Medical Center.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center. Electronic address: yuichiroy@gmail.com.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004733:Enema / Q000009:adverse effects; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019736:Prostheses and Implants / Q000009:adverse effects; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000208:ethnology / Q000517:prevention & control*; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult
keywords: Infection; Myelodysplasia; Urologic surgical procedures; Ventriculoperitoneal shunt