Multiple successful revisions of a ventriculoureteral shunt without nephrectomy for the treatment of hydrocephalus: case report.

Abstract

Ventriculoureteral shunts have been described occasionally for patients with complicated hydrocephalus. Repeated successful revision of the distal end of such a shunt has not been reported previously. We report a case in which this was achieved. A 21-year-old woman with long-standing hydrocephalus, numerous prior shunt revisions and failures, and several distal shunt sites was shunted successfully into her right ureter. On two occasions, proximal shunt infections required shunt externalization, and the distal end was reinserted successfully into the same distal ureter both times. The patient recovered well from surgery with no clinical evidence of shunt malfunction. Multiple distal target failures are an unusual but difficult problem in patients with hydrocephalus. Ventriculoureteral shunts without nephrectomy should be considered, and they can be reused successfully if necessary.