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To validate the effectiveness of Deflux® treatment for vesicoureteral reflux (VUR) following pediatric renal transplantation (RT), based on our single-institution experience. A retrospective study was conducted using the medical records of pediatric patients who underwent Deflux® treatment for VUR after RT from April 2008 to March 2022. Sixty-eight pediatric patients underwent RT. VUR was subsequently detected in 22 (32 %) of these patients. Seven of the 22 patients (32 %) underwent Deflux® treatment to avoid renal dysfunction due to urinary infection (UTI). The median age at the time of RT was 4 years (range:2–12). All 7 patients had urinary UTIs before Deflux® treatment. The median estimated glomerular filtration rate (eGFR) before Deflux® treatment was 67 ml/min/1.73 m2 (range:42–138 ml/min/1.73 m2). After Deflux® treatment, VUR was downgraded in three cases (43 %). Four patients (57 %) experienced postoperative UTI, two of who underwent a second Deflux® treatment, one underwent submuscular tunnel reconstruction, and the other one experienced UTI without VUR after 1st Deflux® treatment but did not reoccur. All seven patients continued prophylactic medication after Deflux® treatment, without any history of recurrent UTIs during the observation period after treatment (median 37 months [range 7–86 months]). Furthermore, the eGFRs did not significantly decrease after Deflux® treatment (median eGFR 58 ml/min/1.73 m2 [range:33–99 ml/min/1.73 m2], p > 0.1). Deflux® treatment for VUR after RT is technically challenging because the new ureteral orifice is ventrally anastomosed at the bladder. We believe our results indicate the possibility of reducing the frequency of UTIs and contributing to preservation of the renal function after RT. Retrospective Study. Level III. [ABSTRACT FROM AUTHOR]

IntroductionThe aim of this study is to present the results of a multi-institutional outcome analysis conducted to determine the extent of endoscopic Deflux® injection for treating primary vesicoureteral reflux in Japan.MethodsA 22-question survey was distributed to 174 certified pediatric urologists (Ninteii in Japanese) and councilors of the Japanese Society of Pediatric Urology working at 140 centers to determine the usage and clinical efficacy of Deflux® for treating primary vesicoureteral reflux in Japan.ResultsForty-three of 140 (30.7%) centers participated, which exceeded participation rates of 27.9 and 18.0% for similar surveys conducted in America in 2006 and 2014, respectively. Deflux® was administered at 43 centers using subureteral transurethral injection (n = 19; 44.2%), hydrodistention implantation (n = 5; 11.6%), or double hydrodistention implantation (n = 19; 44.2%) and was the first-line treatment for primary vesicoureteral reflux at 39 (90.7%) centers. Overall, 1,563 ureters were treated in 1,076 patients. The male:female ratio was 527:549; mean follow-up was 5.1 years (range: 3.2–8 years); mean age at diagnosis of primary vesicoureteral reflux was 4.2 years, and mean age at first Deflux® treatment was 6.2 years. Overall cure rates were 65.3% after one Deflux® treatment, 75.3% after two, and 77.3% after three.ConclusionTo the best of our knowledge, this is the first multi-institutional outcome analysis of Deflux® usage for primary vesicoureteral reflux in Japan.

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Background We previously demonstrated feasibility, safety, and a reproducible histologic bulking effect after injection of dextranomer hyaluronic acid copolymer (DxHA) into the gastroesophageal junction of rabbits. In the current study, we investigated the potential for DxHA to augment the lower esophageal sphincter (LES) in a porcine model of gastroesophageal reflux disease (GERD). Methods Twelve Yucatan miniature pigs underwent LES manometry and 24-hour ambulatory pH monitoring at baseline, after cardiomyectomy, and 6 weeks after randomization to endoscopic injection of either DxHA or saline at the LES. After necropsy, the foregut, including injection sites, was histologically examined. Results Pigs in both groups had similar weight progression. Cardiomyectomy induced GERD in all animals, as measured by a rise in the median % of time pH < 5 from 0.6 to 11.6 (p = 0.02). Endoscopic injection of DxHA resulted in a higher median difference in LES length (1.8 cm vs. 0.4 cm, p = 0.03). In comparison with saline injection, DxHA resulted in 120% increase in LES pressure, and 76% decrease in the mean duration of reflux episodes, but these results were not statistically significant. Injection of DxHA induced a foreign body reaction with fibroblasts and giant cells. Conclusions Porcine cardiomyectomy is a reproducible animal GERD model. Injection of DxHA may augment the LES, offering a potential therapeutic effect in GERD. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study aims to assess pediatric urology practice patterns and factors which influence the use of Deflux® in the management of vesicoureteral reflux among pediatric urologists. Methods: A 11-question survey was sent out to 476 pediatric urologists who are members of the Society for Pediatric Urology. Results: 23.7% of pediatric urologists use Deflux® as first line therapy for Grade III reflux or higher. The presence of renal scarring is not a deterrent to the use of Deflux®. 17.7% would use Deflux® before a trial of observation with or without chemoprophylaxis. In children who are on observation, 20.3% would perform Deflux® when they are at an age considered appropriate for surgery as opposed to continued observation. The majority of pediatric urologists cite Deflux® success rates of >70% to >80% for Grades II–III and >50% to >60% for Grades IV–V. 23.3% of respondents indicated that new evidence citing low long-term success rates at one year decreased their use of Deflux®. 59.8% of respondents indicated they would perform a second injection after an initial failure. Ultrasound and VCUG are used as follow-up in 86.9% and 65.4% respectively after Deflux®; the majority are performed within the first 3 months, rarely at one year. Conclusion: The use of Deflux® is growing and whether it surpasses open reimplantation and chemoprophylaxis as first-line therapy remains to be seen. With new literature showing lower success rates, long-term follow-up with repeat imaging may be required. [Copyright &y& Elsevier]

Abstract: Objective: Dextranomer-hyaluronic acid (Deflux®), the most widely used compound in the endoscopic treatment of vesico-ureteric reflux (VUR) today, is believed to provoke only minimal inflammation. Reports of calcification of Deflux® are increasing. We ascertain the incidence of Deflux® calcification appearing as distal ureteric calculi on ultrasound. Methods: Three cases (2 external patients) of ureteroscopy for calcified submucosal Deflux® prompted a retrospective review of the notes and imaging of all children treated with Deflux® for VUR between December 2000 and January 2011 at Great Ormond Street Hospital. Results: 232 children (M:F = 5:3) received Deflux® for VUR at median age 2 years (range 2 months–12 years). Follow-up annual ultrasound, performed in all, identified calcification in 2. The interval between Deflux® injection and presentation of its calcification was 4 years. 104 of the 232 children had been followed up for 4–10 years. Considering the observed lag-period, after 4 years the incidence of calcification of Deflux® on ultrasound was 2% (2/104). Conclusions: Patients should be warned that calcification of Deflux® can occur. Misinterpretation as ureteric stones is common and may lead to unnecessary ureteroscopy. In this series, the incidence of calcification of Deflux® on ultrasound after 4 years was 2%. [Copyright &y& Elsevier]

Introduction: The aim of this study is to present the results of a multi-institutional outcome analysis conducted to determine the extent of endoscopic Deflux® injection for treating primary vesicoureteral reflux in Japan., Methods: A 22-question survey was distributed to 174 certified pediatric urologists (Ninteii in Japanese) and councilors of the Japanese Society of Pediatric Urology working at 140 centers to determine the usage and clinical efficacy of Deflux® for treating primary vesicoureteral reflux in Japan., Results: Forty-three of 140 (30.7%) centers participated, which exceeded participation rates of 27.9 and 18.0% for similar surveys conducted in America in 2006 and 2014, respectively. Deflux® was administered at 43 centers using subureteral transurethral injection ( n = 19; 44.2%), hydrodistention implantation ( n = 5; 11.6%), or double hydrodistention implantation ( n = 19; 44.2%) and was the first-line treatment for primary vesicoureteral reflux at 39 (90.7%) centers. Overall, 1,563 ureters were treated in 1,076 patients. The male:female ratio was 527:549; mean follow-up was 5.1 years (range: 3.2-8 years); mean age at diagnosis of primary vesicoureteral reflux was 4.2 years, and mean age at first Deflux® treatment was 6.2 years. Overall cure rates were 65.3% after one Deflux® treatment, 75.3% after two, and 77.3% after three., Conclusion: To the best of our knowledge, this is the first multi-institutional outcome analysis of Deflux® usage for primary vesicoureteral reflux in Japan., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 The Japanese Deflux® Injection Therapy Study Group.)

Vesicoureteral reflux (VUR) is a heterogeneous disease and its management remains one of the most controversial topics in pediatrics. Management options include surveillance, antibiotics, and surgery. The approval of dextranomer/hyaluronic acid (DHA) as a bulking agent by the Food and Drug Administration was followed by wide acceptance of endoscopic techniques as a major tool in the management of reflux. Pyelonephritis rather than VUR is the most common cause of kidney damage in children. It should be emphasized that the primary goal of diagnosing and treating VUR should be preventing this complication. There are no sufficient data in the literature to address the impact of the different treatment modalities on the incidence of febrile urinary tract infections (feb-UTIs) denoting pyelonephritis, with very few studies evaluating endoscopic treatment in light of this clear and well-defined outcome. The fact that we can correct the anatomy at the vesicoureteral junction with a simple and relatively safe outpatient procedure does not justify offering it to all patients. In this review, we attempt to critically evaluate the available literature pertaining to the impact of different treatment modalities on reducing the incidence of febrile UTIs and kidney damage, with a special emphasis on endoscopic treatment. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) after renal transplant in the pediatric population may be associated with an increased incidence of urinary tract infection (UTIs) leading to increased morbidity, including graft dysfunction and graft loss. The non-orthotopic location of the transplanted ureter, and lack of submucosal tunnel may pose challenges in correcting the VUR using endoscopic injection techniques. Herein we report the results of a systematic review evaluating the outcomes of endoscopic treatment of VUR using Deflux® in this population. Pubmed and Embase databases were searched from October 2001 to April 2019. Full-text English articles involving patients less than 18 years old at the time of transplant, with a diagnosis of VUR post-transplantation, who underwent Deflux® treatment were included. Figure 1 outlines our PRISMA-compliant search strategy. We found 6 eligible studies describing Deflux® treatment outcomes in 67 pediatric patients with post-transplant VUR where voiding cystourethrogram (VCUG) confirmed the diagnosis and resolution of VUR. The mean success rate was 36.8%. Ureteral obstruction occurred in 7/67 cases (10.4%). In all these 7 cases of obstruction, ureteric stenting was the initial management, but was only successful in 1 patient. Open ureteroneocystostomy (UNC) was performed in 4/7 cases, while 2/7 were managed expectantly (unknown outcomes). Persistent VUR with UTI despite Deflux® were reported in 20 out of 67 cases. Of these, 7 were managed with prophylactic antibiotics, and 13 with UNC. Success rates were consistently low for UNC after failed Deflux® in comparison to redo UNC in transplant ureters without prior injection. Low success rates are seen following injection techniques for VUR after pediatric renal transplant. Although an appealing option, Deflux® may prove counterintuitive due to the high rate of obstruction and suboptimal results if open reimplantation is required. A multi-institutional prospective study with a larger population size may further elucidate these results. [ABSTRACT FROM AUTHOR]

The article discusses the vesicoureteral reflux (VUR), an abnormality in the urinary tract which affects approximately 1% of children. It states that a repeated urinary tract infection may lead to renal scarring, end-stage renal disease, and hypertension. It mentions the therapeutic use of prophylactic antibiotic which is to reduce risk of urinary tract infection in the VUR population. It concludes that an endoscopic treatment with deflux is an effective and safe option in children with VUR.

The endoscopic injection of vesicoureteric orifices with synthetic or natural materials is a widely recognized method of treating vesicoureteral reflux (VUR). The aim of this study is to present two cases of clinically significant complications following the use of dextranomer/hyaluronic acid copolymer, which led to the progression of the reflux degree, permanent infection of the urinary tract, and the necessity to perform surgical treatment. [ABSTRACT FROM AUTHOR]

The article presents a case study on the evaluation of an 11-year-old girl who has multiple urinary tract infections (UTIs) which were all associated with fever. Based on the history and physical examination, the working diagnosis was vesicoureteral reflux (VUR). To asses for VUR, cystourethrogram (VCUG) was recommended. Also discussed is the use of PIC cystography as an additional means for evaluating VUR.