title: The deflux procedure reduces the incidence of urinary tract infections in patients with vesicoureteral reflux.
abstract: OBJECTIVE
  The aim of this study was to review the experience of a single institution with the Deflux (Q-Med Scandinavia; Uppsala, Sweden) procedure and assess its effectiveness in reducing the incidence of urinary tract infections (UTIs) in children with vesicoureteric reflux (VUR).
  
  
  METHODS
  After institutional review board approval, the charts of 100 patients with VUR, who presented between June 2003 and June 2005, were prospectively reviewed. Data collected included: demographics, the number of preoperative and postoperative UTIs, a radiologic grade of VUR on a voiding cystourethrogram (VCUG) and the presence of VUR on a radionuclide VCUG 3 months after the procedure. Patients were continued on oral antibiotics until urine culture at 3 months was negative and no reflux was demonstrated on VCUG. The student's t test was used for data analysis.
  
  
  RESULTS
  The mean age was 3.8 +/- 0.3 years, and 76% were girls. From 155 ureters treated, 10 had Grade I reflux, 42 Grade II, 76 Grade III, 25 Grade IV, and 2 Grade V. A second injection was required in 22 ureters (14.2%). The overall success rate of the procedure (Grade 0 reflux at 3 months) was 77.4% after the first injection and 83.9% after a second injection. The success rate per grade was: 100% for Grade I, 88.1% for Grade II, 86.8% for Grade III, 64% for Grade IV, and 50% for Grade V. The mean follow-up was 446 +/- 20 days. The mean volume injected/ureter was 0.6 +/- 0.03 mL. Thirteen (13) patients had UTIs after the procedure, compared to 75 before. There was a 5-fold reduction in the incidence of UTIs/year, from a mean of 0.68 +/- 0.09 pre- to 0.12 +/- 0.04 postinjection (P = 0.001). The majority of UTIs were caused by Escherichia coli (74% pre- and 82% postinjection).
  
  
  CONCLUSIONS
  We conclude that the Deflux procedure is effective not only in eliminating VUR on radiologic studies, but also in reducing the incidence of UTIs and antibiotic use in children with VUR.
authors.affiliation: Department of Pediatric Surgery, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA. geowadie2002@yahoo.com
authors.forename: George M
authors.initials: GM
authors.lastname: Wadie
authors.forename: Michael V
authors.initials: MV
authors.lastname: Tirabassi
authors.forename: Richard A
authors.initials: RA
authors.lastname: Courtney
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Moriarty
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000517:prevention & control; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D004927:Escherichia coli Infections / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011446:Prospective Studies; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000145:classification / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid