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Endoscopic Treatment with Deflux® for Refluxing Duplex Systems

Connie J. Rossini, MD, Richard A. Courtney MD, FAAP, FACS, David B. Tashjian MD, FAAP, Kevin P. Moriarty MD, FAAP, FACS
Baystate Medical Center; Springfield, MA


PURPOSE OF STUDY
The aim of this study was to review the experience of a single institution with the endoscopic Deflux® procedure and assess its effectiveness in the treatment of refluxing duplex systems.

METHODS USED:
A retrospective review of all patients that underwent endoscopic Deflux® treatment for vesicoureteral reflux (VUR) in duplex systems between June 2003 and July 2007 was performed. Data collection included: age, gender, side of refluxing ureter, pre-operative radiologic grade of VUR on a voiding cystourethrogram (VCUG), presence of VUR on a radionuclide VCUG three months post procedure, volume of Deflux® injected, number of Deflux® injections performed per patient, and number of patients that underwent re-implantation surgery.

SUMMARY OF RESULTS:
Sixteen patients with duplex systems, two being bilateral, for a total of 18 duplex ureteral systems, underwent the Deflux® procedure. Grades of reflux were as follows: grade II – 4 ureters, grade III – 8 ureters, grade IV – 4 ureters, and grade V – 2 ureters. Deflux® injection volume ranged from 0.28 – 1.5 cc (mean 0.84 cc). Fourteen ureteral systems required one injection, three required two injections, and one required three injections. The overall success rate of the procedure after a maximum of 3 injections was 94%. One patient with pre-operative unilateral grade V reflux had persistent high-grade reflux after two injections and opted to proceed with surgical re-implantation. The mean follow-up was 24 months (6 to 48 months).

CONCLUSIONS:
We conclude that the Deflux® procedure is a safe and effective minimally invasive treatment alternative for patients with refluxing duplex systems.

TABLES AND CHARTS:
Table 1: Patient Demographics
Total number of patients 236
Total number of ureters 362
Duplex systems 16
Bilateral duplex systems 2
Total number of duplex ureters 18
Age in years - Mean 4.9
Range 1-12
Female (%) 14 (87%)
Male 2 (13%)
Grade II Reflux 4 (22%)
Grade III Reflux 8 (44%)
Grade IV Reflux 4 (22%)
Grade V Reflux 2 (11%)

 

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