Deflux injection

Overview

Deflux, which contains hyaluronic acid and dextranomer, is an injectable gel treatment for vesicoureteral reflux (VUR), consisting of two types of sugars and a filler substance. When injected, it adds bulk to the tissue at the injection site. Normally, urine flows downward through the urinary tract—from the kidneys, through the ureters, to the bladder, and out of the body via the urethra. However, VUR causes urine to flow backward from the bladder into the ureters and sometimes to one or both kidneys.

VUR primarily affects newborns, infants, and young children under two years old, though older children and rarely adults can also be affected. Diagnosis is made through a voiding cystourethrogram (VCUG), where a catheter is inserted into the urethra, and contrast dye is injected into the bladder. X-rays are taken before, during, and after urination to check for backward urine flow into the ureters.

Reasons for undergoing the procedure

Normally, urine flows downward from the kidneys through the ureters to the bladder, and out of the body through the urethra. Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the ureters and, in some cases, to one or both kidneys. While VUR primarily affects newborns, infants, and young children under two, it can also rarely affect older children and adults. VUR is diagnosed using a voiding cystourethrogram (VCUG), where a catheter inserts contrast dye into the bladder, and X-rays capture images before, during, and after urination to check for backward urine flow. A treatment option for VUR is Deflux.

Risks

The majority of the hazards are associated with utilizing a cystoscope. These could consist of:

• Bleeding
• Infection
• Ureteric blockage
• Swelling and bruises
• Damage to the bladder
• The procedure’s failure

The primary danger associated with the Deflux technique is the persistence of infections even after therapy. A second or even third injection might be required in certain circumstances.

The bulking effect of Deflux may cause the ureter to get clogged, which is another potential concern. Approximately one child out of every 33 who receives the treatment experiences this.

After the cystoscope is inserted through the urethra, your child may experience discomfort for a day or two. You may notice that your child hesitates to urinate or complains of stinging or discomfort during urination. There might also be bladder spasms, which can feel like cramps or a strong urge to urinate. In severe cases, your child may have difficulty holding urine and could experience bedwetting for a few days. Occasionally, you might observe pink-tinged urine.

Your child might be hesitant to drink fluids during this period, but these symptoms typically improve within a few days. It’s important to encourage your child to drink plenty of fluids to help alleviate discomfort and promote recovery.

During the procedure

This is an outpatient procedure where your child will receive general anesthesia to sleep through the process. A urologist will use a cystoscope, a special tube with a camera on the end, to view the inside of your child’s bladder. The cystoscope is inserted through the urethra and guided into the bladder. This instrument helps the urologist accurately inject Deflux. The entire procedure typically takes about 30 minutes to complete.

After the procedure

After the procedure, your child may feel a bit drowsy, but this will not last long, and they can go home the same day since no incisions are needed. The Deflux gel will gradually be broken down by your child’s body and replaced by their own tissue as they grow, maintaining the length of the ureter tunnel. To ensure the success of the procedure, your child may need to undergo a repeat VCUG.

Outcome

After the cystoscope is inserted through the urethra, your child may experience soreness for a day or two. You might notice some changes such as reluctance to urinate or complaints of stinging or soreness while trying to pee. Bladder spasms, which can feel like cramps or a strong urge to urinate, may occur. In severe cases, your child might not be able to hold urine and could wet the bed for a few days. Pink-tinged urine may also be observed. Your child might not want to drink fluids, but these effects should subside within a few days. Encourage your child to drink as much fluid as possible.

Call your child’s urologist after the Deflux procedure if your child:

• Hasn’t urinated in 8 to 10 hours.
• Has pain when urinating more than two days after the procedure.
• Refuses to go to the bathroom to urinate.
• Has severe pain in the belly, back, or flank.
• Has a fever higher than 101.5 degrees F (38.6 degrees C).
• Experiences worsening bladder spasms that do not decrease within 24 hours.
• Vomits frequently.
• Has pain in the back and hips.