title: Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound.
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%.
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK. Electronic address: Francisca.yankovic@gosh.nhs.uk.
authors.forename: Francisca
authors.initials: F
authors.lastname: Yankovic
authors.forename: Robert
authors.initials: R
authors.lastname: Swartz
authors.forename: Peter
authors.initials: P
authors.lastname: Cuckow
authors.forename: Melanie
authors.initials: M
authors.lastname: Hiorns
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.forename: Abraham
authors.initials: A
authors.lastname: Cherian
authors.forename: Imran
authors.initials: I
authors.lastname: Mushtaq
authors.forename: Patrick
authors.initials: P
authors.lastname: Duffy
authors.forename: Naima
authors.initials: N
authors.lastname: Smeulders
mesh_terms: D000293:Adolescent; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014515:Ureteral Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018666:Ureteroscopy; D014545:Urinary Calculi / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid