Ventriculovesical Shunting in Pediatric Hydrocephalus with Neurogenic Bladder: A Salvage Case Series and Biomechanical Considerations

OBJECTIVE: Ventriculovesical (VV) shunting is an uncommon salvage option for cerebrospinal fluid (CSF) diversion in pediatric patients with complex hydrocephalus when conventional distal shunts are no longer viable. Evidence regarding appropriate patient selection, urological safety, and long-term durability of this technique remains limited. This study aimed to evaluate the clinical outcomes and urological safety for VV shunting in children with neurogenic bladder, with particular attention to urodynamic factors that may influence shunt performance. METHODS: A retrospective case series was conducted including pediatric patients who underwent VV shunt placement after failure or contraindication of conventional CSF diversion routes. Demographic characteristics, neurological diagnoses, bladder dynamics, prior shunt history, and clinical outcomes were reviewed. All patients had underlying neurogenic bladder managed with clean intermittent catheterization. RESULTS: Ten patients underwent VV shunt placement at a median age of 7 years (range 2–13 years). Median follow-up duration was 18,5 months (range 10–42 months). Hydrocephalus control was maintained in nine patients (90%) during follow-up. Distal shunt migration requiring revision occurred in two patients (20%). In one patient, persistent inability to achieve adequate bladder pressure control necessitated conversion to a ventriculo-gallbladder shunt following a period of external ventricular drainage. No intraoperative complications occurred, and no febrile urinary tract infections or bladder stone formation were observed during follow-up. CONCLUSION: VV shunting may represent a viable salvage option for CSF diversion in carefully selected pediatric patients with complex hydrocephalus and neurogenic bladder. Adequate bladder pressure control appears to be a critical determinant of shunt durability, whereas persistently high-pressure bladders may predispose to distal-shunt related complications. These findings highlight the importance of urodynamic assessment and integrated uro-neurosurgical evaluation when considering VV shunting as an alternative CSF diversion strategy and may assist neurosurgeons in identifying appropriate candidates when conventional distal sites are exhausted.