Deflux: Treatment for Vesicoureteral Reflux

Overview

Deflux, which contains hyaluronic acid and dextranomer, is used to treat Vesicoureteral Reflux (VUR). This injectable gel comprises sugars and a filler substance, increasing tissue volume where injected. Normally, urine flows from the kidneys through the ureters to the bladder, a storage organ, and exits the body via the urethra.

Reasons for undergoing the procedure

Vesicoureteral Reflux (VUR) is when urine flows backward from the bladder into one or both ureters, and sometimes into the kidneys. It primarily affects newborns, infants, and children under two years old, but older children and adults can also be affected, albeit rarely. Deflux has been studied extensively for treating VUR, with reported success rates varying between 70% and 93%.

Diagnosis of VUR typically involves a Voiding Cystourethrogram (VCUG). This procedure uses a catheter to inject contrast dye into the bladder until it’s full, followed by X-rays taken before, during, and after urination to detect any backward flow of urine into the ureters.

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.

Risks

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

During the Deflux procedure, a gel-like mixture is injected into the bladder wall near the entry point of the ureter. This gel increases the thickness of that area, creating a bulge. This bulge acts like a valve, reducing the likelihood of urine refluxing back toward the kidney while allowing normal forward flow into the bladder.

This outpatient procedure requires general anesthesia to ensure your child is comfortably asleep. The urologist uses a cystoscope, a specialized tube with a camera, inserted through the urethra to visualize the bladder’s interior. The cystoscope guides the precise placement of the Deflux injection. The entire procedure typically lasts about thirty minutes.

After the procedure

After the procedure, your child may feel slightly drowsy, but this will quickly pass, and they can go home the same day. The procedure is non-invasive and does not involve any incisions.

The gel used in Deflux gradually breaks down in your child’s body over time, eventually replaced by the body’s own tissue as they grow. This helps maintain the proper length of the ureter tunnel.

Following the Deflux procedure, your child can typically resume normal activities the day after. Compared to ureteral reimplant surgery, Deflux requires less healing time.

The Deflux gel is known for its safety and durability. It integrates smoothly with the body and slowly dissolves over time. It has shown minimal tissue reaction at the injection site and remains localized without migrating to other areas of the body.

Your child may need to undergo another VCUG to confirm the success of the procedure.

Outcome

You and your child’s urologist should explore all treatment options for VUR, which include monitoring without treatment (as some children may outgrow it), long-term antibiotic therapy, ureteral reimplant surgery, and Deflux. The suitability of each option depends on the cause and severity of the VUR. Together with the urologist, you will discuss the risks and benefits of each treatment method and consider your child’s individual circumstances to determine the most appropriate approach.

It’s crucial to safeguard your child’s kidneys. Persistent VUR can lead to kidney infections, which may result in damage or scarring, leading to kidney disease, high blood pressure, and other health complications.