title: Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction treated with dextranomer/hyaluronic acid copolymer (Deflux).
abstract: OBJECTIVE
  There has been hesitancy to use dextranomer/hyaluronic acid copolymer (DHXA, Deflux for vesicoureteral reflux (VUR) in the setting of lower urinary tract (LUT) dysfunction because of the limited number of published studies, the possibility of less success, and the manufacturer's recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients whose VUR persisted despite targeted therapy for their LUT condition.
  
  
  METHODS
  We reviewed patients diagnosed with both a LUT condition and VUR who underwent subureteric DXHA while still undergoing treatment for their LUT dysfunction. Persistence of VUR was confirmed by videourodynamic studies (VUDS)/VCUG (voiding cystourethrogram) and all patients were on targeted treatment (TT) and antibiotic prophylaxis prior to and during DXHA injection. VUR was reassessed post-injection.
  
  
  RESULTS
  Fifteen patients (22 ureters; 21F,1M) met inclusion criteria (mean age 6.1 years, range 4-12). Following one to three DXHA injections, VUR resolved in 17 ureters (77%) including eight of nine ureters in dysfunctional voiding (DV) patients, five of nine in idiopathic detrusor overactivity disorder (IDOD), and four of four in detrusor underutilization disorder (DUD) patients.
  
  
  CONCLUSIONS
  DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection.
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA. Electronic address: jpv2107@columbia.edu.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Nees
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Fast
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Combs
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA. Electronic address: kglassberg@aol.com.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra; D014554:Urination / Q000502:physiology*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
keywords: Deflux; Dysfunctional voiding; Lower urinary tract conditions; Pediatrics; Vesicoureteral reflux