You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-10 DELAYED OBSTRUCTION WITH SILENT LOSS OF RENAL FUNCTION AFTER DEXTRANOMER/HYALURONIC ACID COPOLYMER (DEFLUX) INJECTION FOR VESICOURETERAL REFLUX: A CLOSE LOOK AT A DISTURBING OUTCOME Dimitri Papagiannopoulos, Ilina Rosoklija, Earl Cheng, and Elizabeth Yerkes Dimitri PapagiannopoulosDimitri Papagiannopoulos More articles by this author , Ilina RosoklijaIlina Rosoklija More articles by this author , Earl ChengEarl Cheng More articles by this author , and Elizabeth YerkesElizabeth Yerkes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.601AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dextranomer/hyaluronic acid copolymer (Deflux) first received FDA approval in 2001 for endoscopic injection in children with grade II-IV vesicoureteral reflux (VUR). With its minimally invasive nature, high success rates and few reported complications, Deflux has enjoyed widespread popularity. As experience has grown, Deflux implantation has been used in an off-label fashion to included cases of grade V VUR, ureteral duplication, voiding dysfunction, and children less than 12 months old. Post-operative ureteral obstruction has been reported in 1% of cases, and is typically transient in nature, occurring within the first 1-2 weeks of surgery and associated with obstructive symptoms. More recently, documented cases of delayed, silent obstruction and a loss of renal function have surfaced. In hopes of adding awareness to this complication, we present three such cases. METHODS This is an institutional case series of three patients who underwent Deflux injection and developed delayed ureteral obstruction. Pre-operative clinical indications, imaging studies, operative notes, and post-operative course were reviewed. RESULTS Patient ages ranged from 8 months to 7 years at the time of Deflux injection. All three underwent double hydrodistension implantation technique (double-HIT) with 1-2 cc of Deflux per ureter. All three patients underwent off-label use: two had documented voiding dysfunction and one was less than 12 months old. All patients had post-operative imaging with documented resolution of reflux and absence of hydronephrosis followed by a prolonged symptom-free period. Delayed obstruction was identified between 18-52 months post-operatively with evidence of hydronephrosis, parenchymal thinning, and loss of renal function. Two patients were asymptomatic until the time of diagnosis, and one patient had a febrile urinary tract infection that necessitated work-up. All patients required open ureteral remplantation, with observed periureteral rind and pathologically confirmed peri-ureteral inflammation in all cases. CONCLUSIONS In this case series of three patients, delayed obstruction was identified as late as 52 months from Deflux injection, and all were treated in an off-label fashion. We now place increased emphasis on the need for long-term follow-up after Deflux in both routine and complex cases, particularly in situations of off-label use. Unfortunately it appears that silent loss of renal function can occur despite periodic surveillance. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e739 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Dimitri Papagiannopoulos More articles by this author Ilina Rosoklija More articles by this author Earl Cheng More articles by this author Elizabeth Yerkes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...