Deflux injection for the treatment of vesicoureteric reflux in children--a single centre's experience.
BACKGROUND
Vesicoureteric reflux (VUR) is a common condition that may lead to end-staged renal failure. Treatment options include long term prophylactic antibiotics or surgical intervention. Recently, endoscopic treatment by a subureteral injection of Deflux has gained popularity. Our centre has introduced this treatment modality since 2002.


METHODS
The medical records of 42 patients (15 male and 27 female) who received Deflux injections for treatment of VUR from 2002 to 2007 were reviewed. All the patients were followed up with voiding cystourethrograms at 3 months after the procedure.


RESULTS
The median age at operation was 72.59 months (range, 8 to 216 months). Unilateral involvement was found in 20 patients while 22 patients had bilateral involvement. Of the 64 ureters, VUR were grade II to V in six (9.4%), 31 (48.4%), 20 (31.2%) and seven (10.9%) patients respectively. Resolution of reflux, defined as grade 0 to I, after one injection was seen in six (100%), 20 (64.5%), and 16 (80%) ureters from grade II to IV respectively. Only one patient with grade V reflux achieved complete resolution after a single injection. Of the 21 ureters which had residual reflux, three were lost from follow up and 18 (ten grade III, two grade IV and six grade V) received a second injection and eventually 12 ureters achieved resolution. Thus, the overall success rate was 67.2% after a single injection and 85.9% after two injections. No procedure-related complications was reported.


CONCLUSIONS
Injections of Deflux is an effective treatment for VUR. A significant reduction in disease severity was seen in patients with grade II to IV disease after a single injection. Most patients with grade V disease needed more than one injection before achieving complete resolution. With this high success rate, we recommend the use of endoscopic Deflux injection as the first line treatment for children with vesicoureteric reflux disease.
Chung
Patrick Ho Yu
PH
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Lan
Lawrence Cheun Leung
LC
Wong
Kenneth Kak Yuen
KK
Tam
Paul Kwong Hang
PK
D000293:Adolescent; D001672:Biocompatible Materials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D001672:Biocompatible Materials; D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid