Indian Pediatrics

, Volume 55, Issue 12, pp 1046–1049 | Cite as

Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up

  • Kln Rao
  • Prema MenonEmail author
  • R Samujh
  • Jk Mahajan
  • M Bawa
  • Ma Malik
  • Br Mittal
Research Paper



To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance–Dextranomer/ hyaluronic acid copolymer at vesicoureteric junction.


Retrospective analyses of case records.


Pediatric Surgery department in a tertiary care government Institute.


500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016).


Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans.

Main outcome measure

Cessation of VUR and symptomatic relief / clinical success postoperatively at 3 months.


Complete symptomatic relief was obtained in 482 (96.4%) patients. In 681 units where MCU was available, 614 (90%) units showed resolution of VUR.


Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention


Dextranomer Renal scars Urinary tract infection 


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  1. 1.
    RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370:2367–76.CrossRefGoogle Scholar
  2. 2.
    Prisca RA, Gozar H, Prisca AM, Moldovan C, Borda A. Parent compliance: A bad predictor of resolution and a problem in the application of EAU guidelines on vesicoureteral reflux in children. Int Urol Nephrol. 2017;49:741–5.CrossRefGoogle Scholar
  3. 3.
    Puri P, Chertin B, Velayudham M, Dass L, Colhoun E. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol. 2003;170:1541–4.CrossRefGoogle Scholar
  4. 4.
    Puri P, Pirker M, Mohanan N, Dawrant M, Dass L, Colhoun E. Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux. J Urol. 2006;176:1856–9.CrossRefGoogle Scholar
  5. 5.
    Lendvay TS, Sorensen M, Cowan CA, Joyner BD, Mitchell MM, Grady RW. The evolution of vesicoureteral reflux management in the era of dextranomer/hyaluronic acid copolymer: A pediatric health information system database study. J Urol. 2006;176:1864–7.CrossRefGoogle Scholar
  6. 6.
    Cerwinka WH, Grattan–Smith JD, Scherz HC, Kirsch AJ. Appearance of Deflux implants with magnetic resonance imaging after endoscopic treatment of vesicoureteral reflux in children. J Pediatr Urol. 2009;5:114–8.CrossRefGoogle Scholar
  7. 7.
    Capozza N, Caione P. Role of the endoscopic treatment of vesicoureteal reflux. A 16–years’ experience. Minerva Pediatr. 2003;55:607–14.Google Scholar
  8. 8.
    Chandrasekharam VV. Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux): Single–surgeon experience with 48 ureters. Indian J Urol. 2013;29:173–6.CrossRefGoogle Scholar
  9. 9.
    Verma A, Panda SS, Bajpai M. Role of endoscopic treatment of vesico–ureteric reflux in downgrading renin angiotensin system activation. J Pediatr Urol. 2014;10:386–90.CrossRefGoogle Scholar
  10. 10.
    Lavelle MT, Conlin MJ, Skoog SJ. Subureteral injection of Deflux for correction of reflux: analysis of factors predicting success. Urology. 2005;65:564–7.CrossRefGoogle Scholar
  11. 11.
    Garge S, Menon P, Rao KLN, Bhattacharya A, Abrar L, Bawa M, et al. Vesicoureteral reflux: Endoscopic therapy and impact on health related quality of life. J Indian Assoc Pediatr Surg. 2013;18:11–5.CrossRefGoogle Scholar
  12. 12.
    Nortes Cano L, Zambudio Carmona G, Guirao Pinera MJ, Ruiz Jimenez JI. Endoscopic treatment of primary vesicoureteral reflux in childhood. Review of 989 cases in a 9 years period. Cir Pediatr. 2008;21:173–80.Google Scholar
  13. 13.
    Chertin B, Natsheh A, Fadeev D, Shenfeld OZ, Farkas A. Unilateral vesicoureteral reflux and history of contralateral vesicoureteral reflux warranting routine bilateral endoscopic correction. J Urol. 2008;180:1601–3CrossRefGoogle Scholar
  14. 14.
    Vandersteen DR, Routh JC, Kirsch AJ, Scherz HC, Ritchey ML, Shapiro E, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer. J Urol. 2006;176:1593–5.CrossRefGoogle Scholar
  15. 15.
    Boudaoud N, Line A, Pons M, Lefebvre F, Bouche Pillon MA, Francois C, et al. Secondary megaureter: A rare complication of Deflux® endoscopic management of vesicoureteral reflux in children. Arch Pediatr. 2017;24:249–53.CrossRefGoogle Scholar
  16. 16.
    Yankovic F, Swartz R, Cuckow P, Hiorns M, Marks SD, Cherian A, et al. Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound. J Pediatr Urol. 2013;9:820–4.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2018

Authors and Affiliations

  • Kln Rao
    • 1
  • Prema Menon
    • 1
    Email author
  • R Samujh
    • 1
  • Jk Mahajan
    • 1
  • M Bawa
    • 1
  • Ma Malik
    • 1
  • Br Mittal
    • 2
  1. 1.Departments of Pediatric Surgery, PGIMERChandigarhIndia
  2. 2.Departments of Nuclear Medicine, PGIMERChandigarhIndia

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