The Deflux procedure offers a minimally invasive treatment option for vesicoureteral reflux (VUR). This outpatient procedure involves injecting a specialized gel to help correct urine flow, providing an alternative to more invasive surgical interventions.
Understanding Vesicoureteral Reflux
Vesicoureteral reflux (VUR) is a condition where urine in the bladder flows backward into the ureters, sometimes reaching the kidneys. Normally, a one-way valve system at the junction of the ureters and the bladder prevents this backward flow, ensuring urine travels only from the kidneys to the bladder. When this valve system does not function properly, urine can reflux.
This backward movement of urine increases the risk of urinary tract infections (UTIs). Bacteria can be carried up to the kidneys, leading to kidney infections, also known as pyelonephritis. Repeated kidney infections, especially in young children, can lead to kidney scarring and, in rare cases, long-term kidney damage or chronic kidney failure.
The Deflux Procedure Explained
The Deflux procedure enhances the natural valve mechanism at the ureter-bladder junction. It involves injecting a gel into the bladder wall near the opening of the ureter. This gel is a copolymer composed of dextranomer microspheres and hyaluronic acid.
Upon injection, the Deflux gel creates a “bulge” or mound. This bulge acts as a physical barrier, strengthening the one-way valve and preventing backward urine flow. While the hyaluronic acid component gradually breaks down, the non-degradable dextranomer microspheres remain, providing long-term structural support for the corrected valve. Over time, the body’s own tissue infiltrates and surrounds the microspheres, maintaining the bulge and the anti-reflux effect.
What to Expect: Before, During, and After
Preparing for the Deflux procedure involves several steps. Before the procedure, healthcare providers may conduct tests to assess the child’s overall health and the extent of VUR. For young children and toddlers, explaining the procedure in simple, honest terms can help manage anxiety.
The Deflux procedure is typically performed under general anesthesia. A thin, lighted tube with a camera, called a cystoscope, is inserted through the urethra into the bladder. The Deflux gel is injected into the bladder wall near the ureteral opening. The procedure is usually brief, and it is an outpatient procedure, meaning patients can typically go home the same day.
Following the procedure, patients may experience some mild discomfort, such as stinging or soreness during urination, or pink-tinged urine for 24 to 48 hours. Bladder spasms can also occur but usually subside within a day. Encouraging plenty of fluids and allowing the child to rest on the day of the procedure are common recommendations. Most individuals can resume normal activities the day after the procedure, though some children may need to take antibiotics for about three months to prevent infections while the body fully adjusts.
Effectiveness and Potential Considerations
The Deflux procedure has shown high success rates in treating vesicoureteral reflux. Success rates generally range from 70% to 93%, with higher effectiveness in milder (lower grade) VUR. Long-term follow-up studies indicate durable results, with some showing continued efficacy up to 25 years.
While generally considered a safe option, potential considerations exist. These can include a risk of infection or bleeding at the injection site. Reflux may persist or recur, potentially necessitating a repeat Deflux injection or a different surgical approach. Ureteral obstruction has been reported in a small percentage of cases, sometimes requiring temporary stenting. The procedure is most commonly used in children with VUR grades II-IV.