Does deflux alter the paradigm for the management of children with vesicoureteral reflux?

Abstract

The recent approval by the US Food and Drug Administration of Deflux (Q Med, Uppsala, Sweden), a particulate biodegradable polymer of dextran, has led to an understandable enthusiasm for treating children with vesicoureteral reflux by a routinely simple outpatient endoscopic procedure. However, Deflux is but one of a variety of particulate substances, both permanent and absorbable, that have been used to treat reflux in Europe for well over a decade with varying degrees of success. The purpose of this review is to place Deflux in this wider context to anticipate what can be expected realistically regarding the efficacy and potential hazards of this seductive technique and to make recommendations regarding its incorporation, in selected cases, in our therapeutic armamentarium.

Medical versus surgical management for vesicoureteric reflux: the case for medical management

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Nevertheless, the topic often departs from evidence-based medicine, moving towards more subjective (and difficult to challenge) arenas. 18 Unfortunately, the available level of evidence is rather modest, and we continue to practice based on limited data, which mostly address short-term and relatively meaningless outcomes.…”

International Vesicoureteral Reflux Study: unsolved questions remaining

“…Recurrent pyelonephritis or obstructions were the major complications, but remained very rare (~3%) [2][3][4]. Endoscopic submucosal injection techniques have shown variable success rates (55-90%) depending on the grade of VUR and individual experience [5][6][7][8].This point will be important to consider in the future: the lower the rate of surgical failure, the higher will be the number of physicians prone to advise surgical procedure. …”