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Treatment of Vesicoureteral Reflux in Children by Kirsch Endoscopic Injection of Deflux: a 7 Years Experience (Abstract)

Baher Louka, Thierry Merrot, Mamadou Diakite, Pierre Alessandrini

Department of Pediatric Surgery, Hôpital Nord, Université de la Méditerranée

Marseille, France



Objective: The main aim of management of vesicoureteral reflux (VUR) is to prevent or limit the occurrence of renal scars; the procedures for prevention are variable. We evaluate the effectiveness of endoscopic injection of dextranomer/ hyaluronic acid copolymer (Deflux) in the treatment of VUR in children.

Material and Methods: Between 2001 and 2008 a total of 19 boys and 84 girls with a mean age of 4.6 years (range 11 months to 12.3 years) underwent endoscopic correction of VUR with Deflux. Reflux was unilateral in 61 cases and bilateral in 42, affecting 145 ureters. VUR occurred in a single system in 135 ureters and in renal duplication in the remaining 10. Reflux was grade 1 in 9 ureters (6.6%), grade 2 in 68 ureters (50.37%), grade 3 in 45 ureters (33.33%), grade 4 in 12 ureters (8.89%) and grade 5 in one ureter (0.74%). The intervention performed was endoscopic injection of bulking agent (Deflux°) according to Kirsch procedure. At the follow-up at 3 months after a single injection, the reflux was evaluated on the clinical evolution and the voiding cystourethrography.

Results: After a mean follow-up of 28 months, the reflux was corrected in 108 (74.5%) of the 145 ureters. According to the grade of reflux, the success rate was 100%, 81%, 69% and 67% for grades 1 to 4 respectively and VUR persisted in one ureter with grade 5 reflux. The success rate was 57% for refluxing lower pole ureters. There were limitations of this study because this was a single center, retrospective and no randomization therapy.

Conclusions: Although less effective than surgery in high grade reflux, endoscopic injection of Deflux remains a simple and safe procedure that is successful to eliminate reflux in a great majority of patients with low grade VUR.

Key words: vesicoureteral reflux, endoscopic treatment, Deflux, Kirsch.


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