UroToday - This study from Emory University reviewed the Deflux endoscopic injection technique for duplicated systems. They presented their data from over a 6-year experience. They identified 52 children retrospectively that were treated with Deflux for vesicoureteral reflux into duplex ureters. The mean age was 3 years old. They obtained VCUG's at 6 weeks and 3 months after injection to evaluate for the presence of persistent vesicotueral reflux.

Overall, they found that 73% of the patients were cured after the initial treatment. Another six patients were cured with a subsequent injection. It was interesting that seven of the nine initial failures were cases that were downgraded to a Grade I vesicotueral reflux after first injection. There was only one patient with high-grade reflux that required open surgery. This patient had Grade V vesicoureteral reflux before injection.

Overall, the group concluded that endoscopic injection corrected reflux in 85% of children who had duplex systems. They felt that this minimally invasive endoscopic approach is a viable treatment option as a first-line corrective measure for vesicoureteral reflux.

My experience concurs that Deflux corrects between 60-70% of duplex systems with vesicoureteral reflux, with the 60% correction rate being associated more with the high-grade refluxing duplicated systems, and the 70% rate associated more with the Grade II-III refluxing systems. I also feel that the downgrading of the reflux to a Grade I can be considered a success, and we typically ignore Grade I vesicoureteral reflux, but I do applaud the authors for considering the downgrading to a Grade I a failure.

Molitierno JA, Scherz HC, Kirsch AJ
J Pediatr Urol. 2008 Jun;4(3):221-8

Reported by UroToday Medical Editor Pasquale Casale, MD

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