Common questions about Deflux — a non-surgical treatment for VUR

Deflux endoscopic treatment is a non-surgical, minimally invasive injection procedure. Your doctor will use a small camera called a cystoscope (a type of endoscope used to view the bladder) to properly place the gel. The gel is injected where the ureter joins the bladder. During the procedure, your child may be under general anaesthesia. The treatment usually takes about 15 minutes and allows children to go back to normal activities the next day.¹

Most children have success after one injection, while some may need more injection procedures. A 2011 study shows Deflux was proven effective in 93% of children, with no febrile urinary tract infections (febrile UTIs) after one injection.²

Since 1998, Deflux has been used to treat vesicoureteral reflux (VUR) in children. The gel is similar to the natural starches, sugars and tissues in the body. Deflux is made from two tissue-friendly polysaccharides (types of sugar molecules – hyaluronic acid (HA) and dextranomer (Dx).

The hyaluronic acid (HA) is naturally broken down (biodegraded) over a short time and replaced by the body’s own material, while the dextranomer remains in place longer. The HA in Deflux is Non-Animal Stabilised Hyaluronic Acid (NASHA^®), a patented HA technology that is made from non-animal bacteria and crosslinked specifically for optimal stability and biocompatibility. NASHA has been used safely for VUR for over two decades and has been used in more than 40 million procedures worldwide, often as a dermal filler.³

Treatment with Deflux has some potential risks. As with any endoscopic injection procedure, there is a small risk of infection and bleeding from the procedure. In the chance that Deflux can be seen on medical imaging, future doctors should be informed that their patient had a treatment with Deflux. The following adverse events have been reported with Deflux (occurring ≤1%): blockage of the ureters (some rare cases require temporary placement of a ureteric stent). You should ask your paediatric urologist (VUR doctor) about this and other potential side effects.

• The safety and effectiveness of Deflux in pregnant or lactating women has not been established.
  

Your paediatric urologist can help with determining whether Deflux is right for your child. Children with certain types of medical conditions should not be treated with Deflux:

• Primary refluxing megaureters with distal stenosis
• Uncontrolled voiding dysfunction

Some children can outgrow VUR, usually when it’s a mild case. This is what your doctor or paediatric urologist calls spontaneous resolution.

The likelihood of spontaneous resolution varies according to a child’s age, grade of VUR, and whether the VUR is on one ureter or both.

VUR Resolution Chart – Percent Chance of Reflux Resolution After A Specified Number of Years⁴

American Urological Association

Grade	Age	1 Year	5 Years
Grade 3 – One Ureter	2-5 Years Old	13.4%	51.3%
Grade 3 – Both Ureters	2-5 Years Old	7.0%	30.5%
Grade 3 – One Ureter	5-10 Years Old	10.8%	43.6%
Grade 3- Both Ureters	5-10 Years Old	2.6%	12.5%

Treatment is important to protect the kidneys. Kidney infections may cause damage or scarring in the kidneys, which can result in poor kidney function and high blood pressure.

VUR Patients with Renal Scarring Developed Further Conditions⁵

Condition	VUR (No Renal Scarring)	VUR (Renal Scarring)
Proteinuria (Protein in Urine)	1.6%	5.1%
Kidney Disease	0.0%	2.0%
Hypertension (High Blood Pressure)	1.0%	2.8%

This is a discussion you should have with your doctor and a paediatric urologist. In most cases, you have the option of antibiotics, endoscopic treatment with Deflux, or open surgery—all of which have their specific benefits and risks. You want to make sure you understand all that’s involved, from treatment to required follow-up. Only then can you decide what’s right for your family.