Background: Several reports of the safety and effectiveness of dextranomer/ hyaluronic acid (Dx/HA) copolymer (Deflux, Q-Med Scandanavia, Uppsala, Sweden) injections for the treatment of vesicoureteral reflux (VUR) have been in the recent pediatric urologic literature. We report the experience with patients treated for primary vesicoureteral reflux in a teaching children’s hospital setting.
Methods: A total of 79 children 16 months to 14 years old (mean age 7.0 years) were treated for primary VUR with subureteral injection of Dx/HA between August 2002 and March 2005 under the direction of a single supervising surgeon. Average injected volume of Dx/HA was recorded intraoperatively. Follow-up voiding cystourethrograms (VCUG’s) were obtained 3 months post-operatively to assess for VUR.
Results: A total of 120 ureters were treated in 79 children (41 bilateral cases) including 73 girls and 6 boys. Mean maximum grade per patient was 2.4 (out of 5). Average injected volume per ureter was 0.69 +/- 0.29 ml.
Sixty-seven patients had VCUG results available with 3 months of follow-up. Following one treatment, 43 patients (64%) were cured of their reflux (bilateral grade 0), while 50% of failures showed improvement (12 of 24). New contralateral reflux was seen in 8 patients (12%) who had no documented reflux on pre-operative VCUG in a contralateral ureter. The cure rate per grade was 67% for grade I, 71% for grade II, 56% for grade III, and 100% for grade IV (1 patient). There was no statistically significant difference seen in grade, volume injected, bilaterality or gender when patients in the success and failure groups were compared. Age was significantly different (p=0.004) between the success (mean of 7.6 years) and failure (mean of 5.8 years) groups. No improvement in cure rate was seen between the first 20 patients treated when compared to the last 20 patients. No episodes of pyelonephritis, urinary retention or hematuria were seen.
Conclusions: The majority of patients (64%) were cured with a single treatment of subureteral injection of Dx/HA. Cure rates in this series are similar to those seen in previously published reports. This study suggests that older children may have a higher success rate with the procedure than younger children. A number of patients showed new onset of contralateral reflux (12%) at follow-up, suggesting that prophylactic treatment of contralateral non-refluxing ureters may be warranted. This procedure appears to be easily learned and performed with minimal complications as an outpatient procedure in a teaching hospital setting.

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