Why the migration of peritoneal shunt catheter into the scrotum occurs more in children: A systematic literature review

Table 1 Patient demographics and details of ventriculoperitoneal shunt catheter migration into the scrotum in children (n = 112)

Number	Ref.	Indication for VPS insertion	Age VPS insertion	Age scrotal migration	Interval (months)	VPS (revision)	Site1 (right/left)	Operative procedures executed	Outcome
1	Ramani et al[19], 1974	Hydrocephalus (congenital)	Neonate (12 days)	6 months	5 months	No	Right	A	R
2	Levey et al[20], 1977	Hydrocephalus with NTD (congenital)	Neonate (13 days)	1 month	6 days	Yes	Right	A	R
3	Redman et al[21], 1978	Hydrocephalus (congenital?)	N/A	6 months	N/A	No	Right	A	R
4	Bristow et al[22], 1978	Hydrocephalus (congenital)	10 months	10 months	1 day	No	Right	C	R
5	Crofford et al[23], 1983	Hydrocephalus (post haemorrhagic)	Neonate (15 days)	6 months	5 months	No	Right	A	R
6	Crofford et al[23], 1983	Hydrocephalus (congenital)	Neonate (1 month)	3 months	2 months	No	Right	A	R
7	Crofford et al[23], 1983	Hydrocephalus (congenital)	3 months	4 months	1 month	No	Right	A	R
8	Crofford et al[23], 1983	Hydrocephalus (brain tumor)	48 months	50 months	2 months	No	Left	B	R
9	Fuwa et al[24], 1984	Hydrocephalus (congenital)	Neonate (22 days)	12 months	11 months	Yes	Left	I	R
10	Ram et al[25], 1987	Hydrocephalus (post infective)	6 months	36 months	30 months	No	Right	C	R
11	Kwok et al[26], 1989	Hydrocephalus (congenital)	Neonate (1 month)	6 months	1 week	Yes	Bilateral	E	R
12	Calvário et al[27], 1990	Hydrocephalus (congenital)	Neonate (1 month)	24 months	23 months	No	Right	A	R
13	Göçer et al[28], 1990	Hydrocephalus (congenital)	2 months	10 months	8 months	No	Right	C	R
14	Selcuklu[29], 1991	Hydrocephalus with NTD (congenital)	Neonate	8 months	7 months	No	Right	B	R
15	Ammar et al[30], 1991	Hydrocephalus (congenital)	5 months	7 months	2 months	No	Left	G	R
16	Jamjoom et al[31], 1992	Hydrocephalus (congenital)	Neonate (3 weeks)	14 months	2 months	Yes	Right	E	R
17	Wong[32], 1994	Hydrocephalus (congenital)	6 months	7 months	1 month	No	Right	A	R
18	Goh et al[33], 1997	Hydrocephalus (congenital)	Neonate (1 day)	4 months	4 months	No	Right	B	R
19	Oktem et al[34], 1998	Hydrocephalus (congenital)	10 months	16 months	6 months	No	Right	A	R
20	Oktem et al[34], 1998	Hydrocephalus (congenital)	2.5 months	8 months	5 months	No	Right	A	R
21	Oktem et al[34], 1998	Hydrocephalus (congenital)	Neonate (9 days)	4 months	4 months	No	Right	A	R
22	Oktem et al[34], 1998	Hydrocephalus (congenital)	2.5 months	2.5 months	1 day	No	Left	A	R
23	Porras Estrada et al[35], 1999	Hydrocephalus (congenital)	Neonate (1 day)	11 months	5 months	Yes	Left	A	R
24	Ozveren et al[36], 1999	Hydrocephalus with NTD (congenital)	Neonate (3 days)	4 days	1 day	No	Right	A	R
25	Silver et al[37], 2000	Hydrocephalus (congenital)	6 months	36 months	N/A	Yes	Right	F	R
26	Ward et al[38], 2001	Hydrocephalus (post infective)	11 months	18 months	7 months	No	Right	A	R
27	Gupta[39], 2003	Hydrocephalus (congenital)	Neonate	10 months	9 months	No	Right	A	R
28	Henriques et al[40], 2003	Hydrocephalus (post-haemorrhagic)	Neonate	5 months	4 months	No	Right	A	R
29	Walsh et al[41], 2004	Hydrocephalus (congenital)	5 months	11 months	6 months	No	Right	L	N/A
30	de Aquino et al[42], 2006	Hydrocephalus with NTD (congenital)	Neonate (1 day)	14 months	14 months	No	Right	L	R
31	de Aquino et al[42], 2006	Hydrocephalus (congenital)	Neonate (11 days)	1 month	20 days	No	Right	L	R
32	Moon et al[43], 2007	Hydrocephalus (congenital)	4 months	12 years	4 months	Yes	Left	C	R
33	Karaosmanoglu et al[44], 2008	Hydrocephalus with NTD (congenital)	N/A	14 months	N/A	No	Right	G?	R
34	Kayaoğlu et al[45], 2008	Hydrocephalus with NTD (congenital)	Neonate (10 days)	5 months	4 months	No	Right	C	R
35	Agarwal et al[46], 2009	Hydrocephalus (congenital?)	8 months	24 months	7 months	Yes	Right	A	R
36	Rahman et al[47], 2009	Hydrocephalus (brain tumor)	48 months	49 months	1 month	No	Right	C	R
37	de Quintana-Schmidt et al[48], 2010	Hydrocephalus (congenital)	Neonate	2 months	1.6 month	No	Left	A	R
38	Kita et al[49], 2010	Hydrocephalus (brain tumor)	60 months	64 months	4 months	No	Left	A	R
39	Ho et al[50], 2011	Hydrocephalus (congenital)	N/A	14 years	12 months	Yes	Left	F	R
40	Potineni et al[51], 2012	Hydrocephalus (congenital)	2 months	2 months	1 day	No	Left	A	R
41	Mohammadi et al[52], 2012	Hydrocephalus (congenital)	7 months	12 months	5 months	No	Right	A	R
42	Alladi et al[53], 2012	Hydrocephalus with NTD (congenital)	Neonate	20 months	19 months	No	Left	J	R
43	Gupta et al[54], 2012	Hydrocephalus (congenital)	6 months	24 months	18 months	No	Right	A	R
44	Kundal et al[55], 2012	Hydrocephalus (congenital)	6 months	24 months	18 months	No	Right	A	R
45	Rivero-Garvía et al[56], 2013	Hydrocephalus (post infective)	12 months	72 months	60 months	No	Right	A	R
46	Elizabeth et al[57], 2013	Hydrocephalus (post-haemorrhagic)	2 months	14 months	12 months	No	Right	A	R
47	Ghasemi and Ashouri[58], 2013	Hydrocephalus (congenital)	2 months	9 months	7 months	No	Right	A	R
48	Shahizon et al[59], 2013	Hydrocephalus (congenital)	N/A	14 years	7 months	Yes	Left	F	R
49	Panda et al[60], 2013	Hydrocephalus (congenital)	18 months	60 months	42 months	No	Left	A	R
50	Ojo et al[61], 2013	Hydrocephalus (congenital)	10 months	15 months	5 months	No	Left	A	R
51	Erikci et al[62], 2014	Hydrocephalus (congenital)	2 months	48 months	46 months	No	Left	A	R
52	Erikci et al[62], 2014	Hydrocephalus with NTD (congenital)	Neonate (6 days)	2 months	2 months	No	Right	A	R
53	Shankar et al[63], 2014	Hydrocephalus (congenital)	Neonate (1 month)	12 months	11 months	No	Right	A	R
54	Basaran et al[64], 2014	Hydrocephalus (congenital)	Neonate (12 days)	6 months	5 months	No	Right	C	R
55	Kumar and Jagannathan[65], 2015	Hydrocephalus (congenital)	3 months	11 months	8 months	No	Left	A	R
56	Bayindir et al[66], 2015	Hydrocephalus with NTD (congenital)	3 months	18 months	2 months	Yes	Right	A	R
57	Sarangi et al[67], 2016	Hydrocephalus (post infective)	12 months	48 months	36 months	No	Left	G	R
58	Singh et al[68], 2016	Hydrocephalus (congenital)	Neonate	8 months	7 months	No	Right	A	R
59	Singh et al[68], 2016	Hydrocephalus with NTD (congenital)	7 months	14 months	7 months	No	Right	A	R
60	Ricci et al[69], 2016	Hydrocephalus (congenital?)	24 months	10 years	N/A	Yes	Left	I	R
61	Hung et al[70], 2017	Hydrocephalus (post-haemorrhagic)	3 months	5 months	2 months	No	Right	A	R
62	Javadi et al[71], 2017	Hydrocephalus (congenital)	8 months	10 months	2 months	No	Right	A	R
63	Kumar et al[72], 2017	Hydrocephalus with NTD (congenital)	Neonate (14 days)	48 months	47 months	No	Right	A	R
64	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Right	A	R
65	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Right	A	R
66	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Right	A	R
67	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Right	A	R
68	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Right	A	R
69	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Left?	A	R
70	Fernandez-Ibieta et al[73], 2017	Hydrocephalus (congenital)	Neonate	7.5 months (mean)	6.5 months (mean)	No	Left	D	R
71	Bawa et al[74], 2017	Hydrocephalus with NTD (congenital)	3 months	7 months	4 months	No	Right	A	R
72	Bawa et al[74], 2017	Hydrocephalus (congenital)	48 months	51 months	3 months	No	Right	A	R
73	Bawa et al[74], 2017	Hydrocephalus (congenital)	10 months	15 months	5 months	No	Right	A	R
74	Bawa et al[74], 2017	Hydrocephalus (congenital)	48 months	52 months	4 months	No	Right	I	R
75	Paterson et al[75], 2018	Hydrocephalus (congenital?)	11 months	13 months	1 week	Yes	Right	C	R
76	Deora et al[76], 2018	Hydrocephalus (congenital)	3 months	12 months	9 months	No	Right	A	R
77	Shah et al[77], 2018	Hydrocephalus (post infective)	13 months	30 months	17 months	No	Right	A	R
78	Nawaz et al[78], 2018	Hydrocephalus (post infective)	2 months	6 months	4 months	No	Right	A	R
79	Burhan et al[79], 2018	Hydrocephalus (congenital?)	N/A	24 months	N/A	No	Right	A	R
80	Ezzat et al[80], 2018	Hydrocephalus (congenital)	2 months	3 months	1 month	No	Left	A	R
81	Ezzat et al[80], 2018	Hydrocephalus (congenital)	2 months	3 months	1 month	No	Right?	A	R
82	Ezzat et al[80], 2018	Hydrocephalus (congenital)	Neonate (1 month)	2 months	1 month	No	Right?	A	R
83	Soufiany et al[81], 2018	Hydrocephalus (congenital)	Neonate (1 month)	6 months	7 days	Yes	Bilateral	E	R
84	Soufiany et al[81], 2018	Hydrocephalus (N/A)	56 months	60 months	4 months	No	Right	A	R
85	Dharmajaya[82], 2018	Hydrocephalus (congenital)	5 months	12 months	7 months	No	Right	A	R
86	Rajendran et al[83], 2019	Hydrocephalus (congenital)	3 months	36 months	33 months	No	Right	A	R
87	Shedrov et al[84], 2019	Hydrocephalus (congenital)	2 months	9 years	48 months	Yes	Right	F	R
88	Shedrov et al[84], 2019	Hydrocephalus (post hemorrhage)	3 months	24 months	21 months	No	Right	A	R
89	Abdoli et al[85], 2019	Hydrocephalus (congenital?)	23 months	24 months	10 days	No	Right	A	R
90	Abdoli et al[85], 2019	Hydrocephalus (congenital)	2 months	12 months	10 months	No	Right	A	R
91	Abdoli et al[85], 2019	Hydrocephalus (congenital)	5 months	17 months	12 months	No	Right	A	R
92	Abdoli et al[85], 2019	Hydrocephalus (congenital)	8 months	12 months	4 months	No	Left	A	R
93	Chan et al[86], 2019	Hydrocephalus (congenital)	Neonate (16 days)	18 months	17 months	No	Right	H	R
94	Prates Junior et al[87], 2020	Hydrocephalus (congenital)	Neonate (3 days)	1.6 months	1 month	No	Left	I	R
95	Gupta and Gupta[88], 2020	Hydrocephalus (congenital)	Neonate (1 month)	11 months	3 months	Yes	Right	A	R
96	Khaliq et al[89], 2021	Hydrocephalus with NTD (congenital)	Neonate	12 months	11 months	No	Right	A	R
97	Agarwal et al[90], 2021	Hydrocephalus (post infective)	15 months	18 months	3 months	No	Right	D	R
98	Javed et al[91], 2021	Hydrocephalus (congenital)	5 months	5 months	4 days	No	Right	A	R
99	Hauser et al[92], 2021	Hydrocephalus with NTD (congenital)	Neonate (3 weeks)	23 months	22 months	No	Right	B	R
100	Ahmed et al[93], 2021	Hydrocephalus (congenital)	Neonate (1 month)	8 months	7 months	No	Left	A	R
101	Alkhudari et al[94], 2022	Hydrocephalus (post-haemorrhagic)	Neonate?	6 months	5 months?	No	Right	J	R
102	Taha et al[95], 2022	Hydrocephalus with NTD (congenital)	Neonate (1 month)	3 months	2 months	No	Right	A	R
103	Topp et al[96], 2023	Hydrocephalus with NTD (congenital)	Neonate (6 days)	16 months	16 months	No	Right	A	R
104	Tzeng et al[97], 2023	Hydrocephalus (post-haemorrhagic)	Neonate?	2 months?	1 month	No	Right	K	R
105	Chettahi et al[98], 2023	Hydrocephalus (congenital)	Neonate (1 month)	60 months	59 months	No	Right	A	R
106	Joseph et al[99], 2023	Hydrocephalus (congenital)	Neonate (12 days)	6 months	1 month	Yes	Left	K	??
107	Chanchlani et al[100], 2023	Hydrocephalus (congenital)	2 months	2 months	5 days	No	Right	A	R
108	Fitra and Asrizal[101], 2023	Hydrocephalus (congenital)	Neonate (1 month)	1.5 months	2 weeks	No	Left	J	R
109	Kiyak and Cansaran[102], 2023	Hydrocephalus with NTD (congenital)	1.5 months	4 months	2 months	No	Left	B	R
110	Darwish et al[103], 2023	Hydrocephalus (congenital)	Neonate (1 month)	6 months	5 months	No	Right	A	R
111	Castrillo et al[104], 2023	Hydrocephalus (congenital)	Neonate (1 month)	3 months	2 months	No	Right	B	R
112	Javeed et al[105], 2024	Hydrocephalus with NTD (congenital)	6.5 months	7 months	13 days	No	Right	A	R

¹Site: Site of migration.

In tables the cases are listed as in the order of publication i.e.: The case published first in 1974 as first case in table. A: Reposition of migrated distal ventriculoperitoneal shunt catheter into the peritoneal cavity and inguinal herniotomy; B: Reposition (spontaneous) of migrated distal ventriculoperitoneal shunt catheter into the peritoneal cavity and inguinal herniotomy; C: Removal of part of migrated distal ventriculoperitoneal shunt catheter, repositioning of the remaining peritoneal catheter into the peritoneal cavity and inguinal herniotomy; D: Removal of part of migrated distal ventriculoperitoneal shunt catheter, repositioning of the remaining peritoneal catheter into the peritoneal cavity without inguinal herniotomy; E: Removal of migrated/abandoned distal ventriculoperitoneal shunt catheter with repositioning of working distal ventriculoperitoneal shunt catheter into the peritoneal cavity and inguinal herniotomy; F: Removal of migrated/abandoned distal ventriculoperitoneal shunt catheter and inguinal herniotomy; G: Removal of the entire ventriculoperitoneal shunt catheter alone; H: Removal of the entire ventriculoperitoneal shunt catheter and inguinal herniotomy; I: Removal of entire ventriculoperitoneal shunt catheter with re-ventriculoperitoneal shunt insertion/ventriculoperitoneal shunt revision and inguinal herniotomy; J: Surgical therapy not required for the migrated distal ventriculoperitoneal shunt catheter; K: Surgical therapy not done for the migrated distal ventriculoperitoneal shunt catheter; L: Surgical therapy details not available for the migrated distal ventriculoperitoneal shunt catheter; N/A: Not available/details not available; NTD: Neural tube defect; R: Recovered; VPS: Ventriculoperitoneal shunt.

Table 2 Patient demographics and details of ventriculoperitoneal shunt catheter migration in adults and older people (n = 8)

Number	Ref.	Indication for VPS insertion	Age VPS insertion	Age scrotal migration	Interval	VPS (revision)	Site (right/left)	Operative procedures executed	Outcome
1	Rehm et al[106], 1997	Hydrocephalus (brain tumor)	46 years	50 years	4 years	No	Right	G	Death
2	Korfias et al[107], 2013	Hydrocephalus (arachnoid cyst)	29.6 years	30 years	6 months	No	Left	A	R
3	Lee et al[108], 2015	Hydrocephalus (NPH)	65 years	65 years	7 days	No	Right	D	R
4	Foster et al[109], 2019	Hydrocephalus (post haemorrhagic)	Infant? (N/A)	27 years	Days?	Yes	Right	B	R
5	Perret et al[110], 2021	Hydrocephalus (N/A)	16 years	22 years	6 years	No	Right	I	R
6	Khoudir et al[111], 2022	Hydrocephalus (NPH)	75 years	75.4 years	4 months	No	Right	C	R
7	Ndongo Sonfack et al[112], 2022	Hydrocephalus (NPH)	73 years	73 years	2 days	Yes	Right	A	R
8	Vicaría and Unzué[113], 2022	Hydrocephalus (NPH)	80 years	80.2 years	47 days	No	Right	G	Death

A: Reposition of migrated distal ventriculoperitoneal shunt catheter into the peritoneal cavity and inguinal herniotomy; B: Reposition (spontaneous) of migrated distal ventriculoperitoneal shunt catheter into the peritoneal cavity and inguinal herniotomy; C: Removal of part of migrated distal ventriculoperitoneal shunt catheter, repositioning of the remaining peritoneal catheter into the peritoneal cavity and inguinal herniotomy; D: Removal of part of migrated distal ventriculoperitoneal shunt catheter, repositioning of the remaining peritoneal catheter into the peritoneal cavity without inguinal herniotomy; G: Removal of the entire ventriculoperitoneal shunt catheter alone; I: Removal of entire ventriculoperitoneal shunt catheter with re-ventriculoperitoneal shunt insertion/ventriculoperitoneal shunt revision and inguinal herniotomy; N/A: Not available/details not available; NPH: Normal pressure hydrocephalus; R: Recovered; VPS: Ventriculoperitoneal shunt.

Table 3 Yearly overview of literature included in the systematic review (n = 95)

Publication (year-wise)	Group A	Group B	Total (A+B)	Standard deviation	Mean	95%CI (margin of error)
1974–1980	4	0	4	2	2	2-2.772 (± 138.59%)
1981–1985	2	0	2	1	1	1-1.386 (± 138.59%)
1986–1990	4	0	4	2	2	2-2.772 (± 138.59%)
1991–1995	4	0	4	2	2	2-2.772 (± 138.59%)
1996–2000	5	1	6	2	3	3-2.772 (± 92.40%)
2001–2005	4	0	4	2	2	2-2.772 (± 138.59%)
2006–2010	8	0	8	4	4	4-5.544 (± 138.59%)
2011–2015	17	2	19	7.5	9.5	9.5-10.394 (± 109.42%)
2016–2020	22	1	23	10.5	11.5	11.5-14.552 (± 126.54%)
2021–2024	17	4	21	6.5	10.5	10.5-9.009 (± 85.80%)
Total	87	8	95	39.5	47.5	47.5-54.744 (± 115.25%)

Table 4 Yearly overview of cases included in the systematic literature review (n = 120)

Publication (year-wise)	Group A cases	Group B cases	Total (A+B)	Standard deviation	Mean	95%CI (margin of error)
1974–1980	4	0	4	2	2	2-2.772 (± 138.59%)
1981–1985	5	0	5	2.5	2.5	2.5-3.465 (± 138.59%)
1986–1990	4	0	4	2	2	2-2.772 (± 138.59%)
1991–1995	4	0	4	2	2	2-2.772 (± 138.59%)
1996–2000	8	1	9	3.5	4.5	4.5-4.851 (± 107.79%)
2001–2005	4	0	4	2	2	2-2.772 (± 138.59%)
2006–2010	9	0	9	4.5	4.5	4.5-6.237 (± 138.59%)
2011–2015	18	2	20	8	10	10-11.087 (± 110.87%)
2016–2020	39	1	40	19	20	20-26.333 (± 131.66%)
2021–2024	17	4	21	6.5	10.5	10.5-9.009 (± 85.80%)
Total	112	8	120	52	60	60-72.068 (± 120.11%)

Table 5 Literature excluded from the systematic review (n = 9)

Ref.	Number of cases	Literature retrieved	Reason for exclusion
Cooper et al[114], 1976	1	Abstract	Full text not retrieved
Villarejo et al[115], 1980	1	Abstract	Full text not retrieved
Kobayashi et al[116], 1987	2	Abstract	Full text not retrieved
Albala et al[117], 1989	1	Abstract	Full text not retrieved
Celik et al[118], 2005	1	Full text	Incomplete case details
Aly et al[119], 2015	3	Full text	Incomplete case details
Vagholkar et al[120], 2016	1	Full text	Incomplete case details
Montasr[121], 2020	1	Abstract	Incomplete case details
Wu et al[122], 2024	1	Abstract	Full text not retrieved

Table 6 Comparison of results for group A and group B cases, n (%)

Details	Description	Group A	Group B	Total (A+B)	Standard deviation	Mean	95%CI (margin of error)
Cases	Total	112 (93.33)	8 (6.66)	120 (100)	52	60	60-72.068 (± 120.11%)
Location	Right side	83 (69.16)	7 (5.83)	90 (75)	38	45	45-52.665 (± 117.03%)
	Left side	27 (22.5)	1 (0.83)	28 (23.33)	13	14	14-18.017 (± 128.69%)
	Bilateral	2 (1.66)	0 (00)	2 (1.66)	1	1	1-1.386 (± 138.59%)
Indication (ventriculoperitoneal shunt insertion)	Congenital pathologies	94 (78.33)	0 (00)	94 (78.33)	47	47	47-65.139 (± 138.59%)
	Post-hemorrhagic	7 (5.83)	1 (0.83)	8 (6.66)	3	4	4-4.158 (± 103.94%)
	Brain tumor	3 (2.5)	2 (1.66)	5 (4.16)	0.5	2.5	2.5-0.693 (± 27.72%)
	Normal pressure hydrocephalus	0 (00)	4 (3.33)	4 (3.33)	2	2	2-2.772 (± 138.59%)
Interval	0-12 months	88 (73.33)	6 (5)	94 (78.33)	41	47	47-56.823 (± 120.90%)
	13-24 months	10 (8.33)	0 (00)	10 (8.33)	5	5	5-6.93 (± 138.59%)
Surgical procedure executed	Group A	73 (60.83)	2 (1.66)	75 (62.5)	35.5	37.5	37.5-49.2 (± 131.20%)
	Group B	6 (5)	1 (0.83)	7 (5.83)	2.5	3.5	3.5-3.465 (± 98.99%)
	Group C	8 (6.66)	1 (0.83)	9 (7.5)	3.5	4.5	4.5-4.851 (± 107.79%)
Mortality	Postoperative	0 (00)	2 (1.66)	2 (1.66)	1	1	1-1.386 (± 138.59%)