Resolution of urinary incontinence in a chronically constipated pediatric patient with change of ventriculoperitoneal shunt position

Abstract

A 7 year old male with congenital hydrocephalus, seizures, had undergone a ventriculoperitoneal shunt (VPS) procedure. A year ago he underwent a revision with placement of a second shunt, which was complicated by a shunt infection and difficult placement requiring a general surgery consultation at his local hospital. Subsequently he complained of lower abdominal pain and bladder spasms which were treated medically without success. He had been toilet trained for urine and stool by three years of age, and had a history of chronic constipation. The patient developed urinary incontinence upon standing and bending over, and was often noted to be wet. Radiographic examination demonstrated the functional VPS catheter had shifted to a looped position around the bladder, and the disconnected shunt tubing in the lower pelvis with its tip near the bladder. The patient had laparoscopic manipulation and revision of the VPS tubes, shifting the functional catheter away from the pelvis and removal of part of the nonfunctional catheter with resolution of the positional stress urinary incontinence and the abdominal pain. VPS catheters are known to migrate to different positions, and in unusual cases have been found in locations distant and ectopic to the abdomen. The identical urinary problems including enuresis, urinary incontinence and urinary tract infections are associated with chronic constipation in children, and are known to improve with long-term treatment of constipation. Review of the literature did not reveal any report of positional urinary incontinence associated with ventriculoperitoneal shunt devices in children or adults.