Long-term follow-up of ventriculoureteral shunts for treatment of hydrocephalus.

Surgical relief of hydrocephalus is achieved mainly with ventriculoperitoneal or ventriculoatrial shunting. In some patients, frequent reoperations are required because of infection, obstruction, or other complications, thus subjecting them to excessive operative morbidity and risk of neurological damage. One option that has been rarely addressed in recent years is drainage of cerebral spinal fluid into the urinary tract by way of a ventriculoureteral shunt. Patients who have endured multiple revisions of standard cerebral spinal fluid shunts may benefit from a relatively lower frequency of reoperation following ventriculoureteral shunting. There are several complications peculiar to this procedure, however, including ascending infection from the bladder, proximal shunt migration out of the ureter or distal migration into the bladder, failed urinary diversion, and electrolyte disturbances associated with volume depletion. Long-term follow-up of patients with ventriculoureteral shunts has not been reported. We describe the course of 4 patients successfully treated with ventriculoureteral shunts for an average of more than five years per patient. Although all eventually required reoperation, the frequency of reoperation with the ventriculoureteral shunts was markedly lower than with the standard shunts in these patients. Ventriculoureteral shunting should be considered for cerebral spinal fluid drainage in selected patients with multiple failures of standard shunts, provided the bladder is a low pressure reservoir with no urine infection.