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Post-Deflux Procedure Appearance
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • DHA, DxHA, copolymer of hyaluronic acid
            • Deflux most commonly used in USA; Dexell & Macroplastique also used in Europe/Asia
          • Definitions

            • Bulking agent injected near ureterovesical junction (UVJ) to alter UVJ orientation & prevent vesicoureteral reflux (VUR)
              • Deflux (Q-Med; Uppsala, Sweden): Dextranomer-hyaluronic acid copolymer
                • In use clinically since 1995
                • Relatively large particle size inhibits migration
                • Biodegradable, stable in vivo
              • Dexell (Istem Medical; Ankara, Turkey)
                • Manufactured since 2007
                • Polycationic derivative of Dextran & cross-linked hyaluronic acid
                • Similar size & biologic profile to Deflux
              • Macroplastique (Congentix; Geleen, Netherlands)
                • FDA approved in 2006
                • Flexible, soft, textured implants of heat-vulcanized polydimethylsiloxane (solid silicone elastomer)
                • Suspended in bioexcretable polyvinylpyrrolidone gel

          IMAGING

          • General Features

            • Radiographic Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Natural History & Prognosis

                        Selected References

                        1. Romain J et al: Delayed-onset ureteral obstruction and calcification masquerading as renal colic following Deflux° injection. Urology. ePub, 2016
                        2. Kirsch AJ et al: Evaluation of new Deflux administration techniques: intraureteric HIT and double HIT for the endoscopic correction of vesicoureteral reflux. Expert Rev Med Devices. 11(5):439-46, 2014
                        3. Verma A et al: Role of endoscopic treatment of vesico-ureteric reflux in downgrading renin angiotensin system activation. J Pediatr Urol. 10(2):386-90, 2014
                        4. Cambareri GM et al: Practice patterns among pediatric urologists in the use of Deflux® for vesicoureteral reflux: a survey. J Pediatr Urol. 9(6 Pt A):955-61, 2013
                        5. Hidas G et al: Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution? J Urol. 189(5):1882-5, 2013
                        6. Rubenwolf PC et al: Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series. Urology. 81(3):659-62, 2013
                        7. Yankovic F et al: Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound. J Pediatr Urol. 9(6 Pt A):820-4, 2013
                        8. Kaye JD et al: Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: Defining measures of success. J Pediatr Urol. 8(3):297-303, 2011
                        9. Kraft KH et al: Is Endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with overactive bladder? Urology. 78(3):675-8, 2011
                        10. Palagiri AV et al: Distal ureteral calcification secondary to deflux injection: a reality or myth? Urology. 77(5):1217-9, 2011
                        11. Cerwinka WH et al: Radiologic features of implants after endoscopic treatment of vesicoureteral reflux in children. AJR Am J Roentgenol. 195(1):234-40, 2010
                        12. Chertin B et al: Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances. J Pediatr Urol. 6(3):251-6, 2010
                        13. Peters CA et al: Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 184(3):1134-44, 2010
                        14. Romero NP et al: Deflux injections for vesicoureteral reflux in transplanted kidneys. Transplant Proc. 42(8):2892-5, 2010
                        15. Sorensen MD et al: Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux. Pediatr Surg Int. 26(5):509-13, 2010
                        16. Williams MA et al: Endoscopic Deflux injection for pediatric transplant reflux: a feasible alternative to open ureteral reimplant. J Pediatr Urol. 4(5):341-4, 2008
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Top Differential Diagnoses

                              • Clinical Issues

                                TERMINOLOGY

                                • Abbreviations

                                  • DHA, DxHA, copolymer of hyaluronic acid
                                  • Deflux most commonly used in USA; Dexell & Macroplastique also used in Europe/Asia
                                • Definitions

                                  • Bulking agent injected near ureterovesical junction (UVJ) to alter UVJ orientation & prevent vesicoureteral reflux (VUR)
                                    • Deflux (Q-Med; Uppsala, Sweden): Dextranomer-hyaluronic acid copolymer
                                      • In use clinically since 1995
                                      • Relatively large particle size inhibits migration
                                      • Biodegradable, stable in vivo
                                    • Dexell (Istem Medical; Ankara, Turkey)
                                      • Manufactured since 2007
                                      • Polycationic derivative of Dextran & cross-linked hyaluronic acid
                                      • Similar size & biologic profile to Deflux
                                    • Macroplastique (Congentix; Geleen, Netherlands)
                                      • FDA approved in 2006
                                      • Flexible, soft, textured implants of heat-vulcanized polydimethylsiloxane (solid silicone elastomer)
                                      • Suspended in bioexcretable polyvinylpyrrolidone gel

                                IMAGING

                                • General Features

                                  • Radiographic Findings

                                    • Ultrasonographic Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          CLINICAL ISSUES

                                          • Presentation

                                            • Natural History & Prognosis

                                              Selected References

                                              1. Romain J et al: Delayed-onset ureteral obstruction and calcification masquerading as renal colic following Deflux° injection. Urology. ePub, 2016
                                              2. Kirsch AJ et al: Evaluation of new Deflux administration techniques: intraureteric HIT and double HIT for the endoscopic correction of vesicoureteral reflux. Expert Rev Med Devices. 11(5):439-46, 2014
                                              3. Verma A et al: Role of endoscopic treatment of vesico-ureteric reflux in downgrading renin angiotensin system activation. J Pediatr Urol. 10(2):386-90, 2014
                                              4. Cambareri GM et al: Practice patterns among pediatric urologists in the use of Deflux® for vesicoureteral reflux: a survey. J Pediatr Urol. 9(6 Pt A):955-61, 2013
                                              5. Hidas G et al: Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution? J Urol. 189(5):1882-5, 2013
                                              6. Rubenwolf PC et al: Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series. Urology. 81(3):659-62, 2013
                                              7. Yankovic F et al: Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound. J Pediatr Urol. 9(6 Pt A):820-4, 2013
                                              8. Kaye JD et al: Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: Defining measures of success. J Pediatr Urol. 8(3):297-303, 2011
                                              9. Kraft KH et al: Is Endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with overactive bladder? Urology. 78(3):675-8, 2011
                                              10. Palagiri AV et al: Distal ureteral calcification secondary to deflux injection: a reality or myth? Urology. 77(5):1217-9, 2011
                                              11. Cerwinka WH et al: Radiologic features of implants after endoscopic treatment of vesicoureteral reflux in children. AJR Am J Roentgenol. 195(1):234-40, 2010
                                              12. Chertin B et al: Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances. J Pediatr Urol. 6(3):251-6, 2010
                                              13. Peters CA et al: Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 184(3):1134-44, 2010
                                              14. Romero NP et al: Deflux injections for vesicoureteral reflux in transplanted kidneys. Transplant Proc. 42(8):2892-5, 2010
                                              15. Sorensen MD et al: Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux. Pediatr Surg Int. 26(5):509-13, 2010
                                              16. Williams MA et al: Endoscopic Deflux injection for pediatric transplant reflux: a feasible alternative to open ureteral reimplant. J Pediatr Urol. 4(5):341-4, 2008