deflux in reflux - pedsurgerydelhi.com€¦ · the reflux rate is 54% among girls ages 1 to 3 years...
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Deflux In Reflux
Dr Prashant jain
Vesicoureteric Reflux
• Refers to a condition in which
urine flows from the bladder
BACKWARDS up the ureter
and back into the kidneys
• Primary:
Due to defect in the uretero-
vesical valves
• Secondary:
Neurogenic/Obstruction
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Epidemiology of VUR
the most common urologic finding in children, occurring in approximately
1% of newborns
With UTI:
About 30-45% of children have VUR following first confirmed UTI1
The reflux rate is 54% among girls ages 1 to 3 years with a history of
febrile UTI2
The risk of febrile UTI recurrence is approximately 30% in children with
grade III or IV reflux3-5
Recurrence rate may be lower in reflux grade I and II
5-10% of Pediatric ESRD is due to Reflux Nephropathy
1. Conway PH, et al. JAMA. 2007;298(2):179-186. 2. Jodal U. Infect Dis Clin North Am. 1987;1:713-729.
3. Pennesi M, et al. Pediatrics. 2008;121:e1489-1494. 4. Montini G, et al. Pediatrics. 2008;122:1064-1071.
5. Brandstrom P, et al. J Urol. 2010;184:286-291.
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Symptoms
Antenatal hydronephrosis
Febrile UTI is a defining symptom
Unexplained fever
Urine dribbling between urinating
Dysuria (pain on urination)
Strong-smelling, cloudy, or bloody urine (hematuria)
Abdominal, back, or side pain
VUR grades
• The severity of VUR is based upon a grading system, reflecting the extent of reflux
and ureter abnormality1
• More severe VUR is associated with more severe renal scarring and increased
complications2,3
1AUA Guidelines 1997; 2Gonzalez 2005; 3Caione 2004
Kidney
Ureter
Bladder
Kidney
Ureter
Bladder
Kidney
Ureter
Bladder
Kidney
Ureter
Bladder
Kidney
Ureter
Bladder
Grade I Grade II Grade III Grade IV Grade V
Renal Scarring
• VUR + Pyelonephritis:
The odds of renal scarring in
children with VUR and
pyelonephritis are 2.8 times
greater than the odds of
scarring for children with
pyelonephritis without VUR.
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Renal Scarring Increases with Severity of VUR
Patients (N=161) included boys (n=41; mean age 1.2 years) and girls (n=120; mean age 2.9
years) with VUR grades 0 to V; no children had grade V reflux.
Gonzalez E, et al. J Urol. 2005;173:571-574
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Frequency (%) of Renal Scarring in Children Following
Febrile UTI With Acute Lesions
47%
60%
78%
Definition of success in VUR treatment
Aim of treatment
• Protect against febrile UTIs
• Prevent renal scarring
Definition of success
• The successful prevention of febrile UTIs that could lead to renal scarring
VUR Treatment Options
Prophylactic Antibiotics Open Surgery
Curative 83% Success Rate**
Duration of Treatment 1 – 5 years*
Endoscopic Injection
Curative 95% Success Rate
Duration of Treatment up to 3 days (inpatient)1
Not Curative 5 – 13% Annual Resolution
* Optimal duration of antibiotic prophylaxis is undetermined but clinical studies have used 1-5 years
** Majority of patients are cured after a single treatment
Duration of Treatment 1 day (outpatient)1
1Kobelt 2003
What is Deflux?
• Viscous substance
• Combination of Hyaluronic acid and Dextronomer
• Bulking agent and coapts the ureteric orifice during
bladder filling and emptying
• Safe and well tolerated
• Reproducible
• No major adverse reactions
• Does not alter the open surgery success
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STING technique
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Submucosal plane of the INTRAVESICAL URETER
STING technique (Subureteric transurethral injection)
The tip of the DEFLUX needle is inserted under the bladder mucosa 2 to 3 mm below the ureteral orifice at 6 o’clock position
The needle tip is positioned in submucosal plane of the INTRAVESICAL URETER
DEFLUX is injected until a prominent bulge appears and the orifice has a crescent-like shape
.
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