Bulking agent injected near ureterovesical junction (UVJ) to alter UVJ orientation & prevent vesicoureteral reflux (VUR)
Deflux (Q-Med; Uppsala, Sweden): Dextranomer-hyaluronic acid copolymer (DHA, DxHA); most commonly used in USA
In use clinically since 1995, FDA approved 2001
Relatively large particle size inhibits migration
Biodegradable, stable in vivo
Dexell (Istem Medical; Ankara, Turkey); most commonly used in Europe
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
Polydimethylsiloxane (solid silicone elastomer)
Suspended in bioexcretable polyvinylpyrrolidone gel
Vantris (Promedon; Cordoba, Argentina)
Manufactured since 2005
Polyacrylate-polyalcohol copolymer not biodegraded
Induces fibrotic response → difficult revision
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Selected References
Kirsch AJ et al: Non-animal stabilized hyaluronic acid/dextranomer gel (NASHA/Dx, Deflux) for endoscopic treatment of vesicoureteral reflux: what have we learned over the last 20 years? Urology. ePub, 2021
Steinborn M et al: The color Doppler twinkling artifact of implants after endoscopic treatment of vesicoureteral reflux in children: a common finding with high potential for misdiagnosis. J Pediatr Urol. ePub, 2021
Alizadeh F et al: A comparison between dextranomer/hyaluronic acid and polyacrylate polyalcohol copolymer as bulking agents for treating primary vesicoureteral reflux. Urol J. 16(2):174-9, 2019
Friedmacher F et al: Ureteral obstruction after endoscopic treatment of vesicoureteral reflux: does the type of injected bulking agent matter? Curr Urol Rep. 20(9):49, 2019
Han DS et al: Reflux timing is a predictor of successful endoscopic treatment of vesicoureteral reflux. Urology. 124:237-40, 2019
Wang HH et al: Endoscopic treatment for post-transplant vesicoureteral reflux. Transplant Proc. 51(5):1420-3, 2019
García-Aparicio L et al: Randomized clinical trial between polyacrylate-polyalcohol copolymer (PPC) and dextranomer-hyaluronic acid copolymer (Dx/HA) as bulking agents for endoscopic treatment of primary vesicoureteral reflux (VUR). World J Urol. 36(10):1651-6, 2018
Leung L et al: Endoscopic injection for primary vesicoureteric reflux: predictors of resolution and long term efficacy. J Pediatr Surg. 52(12):2066-9, 2017
Romain J et al: Delayed-onset ureteral obstruction and calcification masquerading as renal colic following Deflux° injection. Urology. 94:218-20, 2016
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
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
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
Hidas G et al: Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution? J Urol. 189(5):1882-5, 2013
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
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
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
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
Palagiri AV et al: Distal ureteral calcification secondary to deflux injection: a reality or myth? Urology. 77(5):1217-9, 2011
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
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
Peters CA et al: Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 184(3):1134-44, 2010
Romero NP et al: Deflux injections for vesicoureteral reflux in transplanted kidneys. Transplant Proc. 42(8):2892-5, 2010
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
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
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
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 (DHA, DxHA); most commonly used in USA
In use clinically since 1995, FDA approved 2001
Relatively large particle size inhibits migration
Biodegradable, stable in vivo
Dexell (Istem Medical; Ankara, Turkey); most commonly used in Europe
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
Polydimethylsiloxane (solid silicone elastomer)
Suspended in bioexcretable polyvinylpyrrolidone gel
Vantris (Promedon; Cordoba, Argentina)
Manufactured since 2005
Polyacrylate-polyalcohol copolymer not biodegraded
Induces fibrotic response → difficult revision
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Selected References
Kirsch AJ et al: Non-animal stabilized hyaluronic acid/dextranomer gel (NASHA/Dx, Deflux) for endoscopic treatment of vesicoureteral reflux: what have we learned over the last 20 years? Urology. ePub, 2021
Steinborn M et al: The color Doppler twinkling artifact of implants after endoscopic treatment of vesicoureteral reflux in children: a common finding with high potential for misdiagnosis. J Pediatr Urol. ePub, 2021
Alizadeh F et al: A comparison between dextranomer/hyaluronic acid and polyacrylate polyalcohol copolymer as bulking agents for treating primary vesicoureteral reflux. Urol J. 16(2):174-9, 2019
Friedmacher F et al: Ureteral obstruction after endoscopic treatment of vesicoureteral reflux: does the type of injected bulking agent matter? Curr Urol Rep. 20(9):49, 2019
Han DS et al: Reflux timing is a predictor of successful endoscopic treatment of vesicoureteral reflux. Urology. 124:237-40, 2019
Wang HH et al: Endoscopic treatment for post-transplant vesicoureteral reflux. Transplant Proc. 51(5):1420-3, 2019
García-Aparicio L et al: Randomized clinical trial between polyacrylate-polyalcohol copolymer (PPC) and dextranomer-hyaluronic acid copolymer (Dx/HA) as bulking agents for endoscopic treatment of primary vesicoureteral reflux (VUR). World J Urol. 36(10):1651-6, 2018
Leung L et al: Endoscopic injection for primary vesicoureteric reflux: predictors of resolution and long term efficacy. J Pediatr Surg. 52(12):2066-9, 2017
Romain J et al: Delayed-onset ureteral obstruction and calcification masquerading as renal colic following Deflux° injection. Urology. 94:218-20, 2016
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
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
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
Hidas G et al: Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution? J Urol. 189(5):1882-5, 2013
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
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
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
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
Palagiri AV et al: Distal ureteral calcification secondary to deflux injection: a reality or myth? Urology. 77(5):1217-9, 2011
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
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
Peters CA et al: Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 184(3):1134-44, 2010
Romero NP et al: Deflux injections for vesicoureteral reflux in transplanted kidneys. Transplant Proc. 42(8):2892-5, 2010
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
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
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.