Systematic review of migration of distal ventriculoperitoneal shunt catheter into the urinary bladder with or without per-urethral extrusion

Abstract

Ventriculoperitoneal shunt (VPS) insertion is the most widely performed surgical procedure for the treatment of hydrocephalus across all age groups but is associated with several complications. The objectives of the present review were to review the demographics, clinical characteristics, operative procedures executed, postoperative major complications, and outcome of the cases published on the management of migration of the distal VPS catheter into the urinary bladder with or without per-urethral extrusion. PubMed, Medline, PubMed Central, Embase, ResearchGate, and Google Scholar database online search was performed to retrieve the published/available literature relating to the above-mentioned complication. Literature/Case reports were retrieved from the year 1974 to June 30, 2020, and those were available in the English language. Thirty-seven cases were included for review, and included n = 20 (54.05%) male, n = 15 (40.54%) female and gender details were not available for n = 2 (5.4%) of the cases. The mean age of the cases at the time of diagnosis of the above complication was 15.27 years. The mean interval from the VPS insertion to the diagnosis of the complication for the entire case was 4.7 years and ranged from 1 day to 26 years. Surgical procedures were performed for the management and were in order of frequency as; (a) removal of entire VPS catheter n = 20, (b) removal of distal VPS catheter n = 10, (c) removal/relocation of distal VPS catheter n = 6, and (d) details not available n = 1. Migration of the distal VPS catheter into the urinary bladder with or without per-urethral extrusion occurred across all the age groups. Seventy percent of the cases were children below the age of 15 years. In 50% of the cases, the complication was documented within 24 months after the VPS insertion. In two-third of the cases, repair of the urinary bladder perforation was not done and that healed spontaneously after the removal of the intra-vesical migrated VPS catheter.