NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
Back to Scientific Program
Back to Annual Meeting
Initial Results of Endoscopic Treatment of Primary Vesicoureteral Reflux (vur) with Dextranomer/Hyaluronic Acid (Deflux) in Single and Duplicated Systems.
Paul A. Merguerian, MD, FAAP1, Kwabena Pobi, MD1, Daniel Herz, MD2.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Mt Sinai Hospital Medical Center, New York, NY,

Purpose: Deflux was approved by the FDA in October 2001 and has gained popularity in the treatment of patients with VUR. The reported success rates after first injection is 67%-84%. The reported success rate in duplicated systems is poor and ranges from 20-40%. We report our experience with endoscopic injection of Deflux both in single and duplicated systems
Material and methods: A retrospective chart review approved by the Institutional Review Boards was performed on all patients who have undergone endoscopic treatment of reflux. The hydrodistention injection technique was utilized. For single ureters an initial intramural injection was performed at the 6 o’clock position and a second subureteric injection. For duplicated systems an intramural injection of the lower pole refluxing ureter was performed along with a subureteric injection of the upper pole nonrefluxing ureter.
Three months after injection a voiding cystourethrogram(VCUG) was performed. The procedure was deemed successful when reflux was found to have resolved on VCUG. The procedure was deemed unsuccessful if reflux of the same grade or lower grade was foung
Results: A total of 97 single system ureteral units and 10 duplicated system ureteral units were treated.
Success rates after single injections were as follows:

 

Ureters

Success

Failures

% success

Grade I

15

13

2

87

Grade II

36

31

5

86

Grade III

36

31

5

86

Grade IV

9

7

2

78

Grade V

1

1

0

100

Total

97

83

14

86

 

 

 

 

 

Duplex

10

9

1

90


Of the 14 failed procedures 9 were retreated with resolution of reflux in 8(89%). The failed procedure in the duplicated ureter was retreated successfully. For duplicated systems this translates to an overall success rate after two injections of 100%.
In our series 3 patients also developed contralateral reflux 3/67 (4%). Two of the three were found to have gaping ureteral orifices on cystoscopic evaluation.
Conclusion: Our limited experience shows that the hydrodistention technique and intramural injection of Deflux allows for a success rate of 86% after the first injection and a higher success rate with a second injection. Injection of both the upper and lower pole ureteral units in duplicated systems allows for a high success rate also in duplicated systems. Longer follow up is required to assess the long term effects of this minimally invasive modality.


Back to Scientific Program
Back to Annual Meeting