What is endoscopic treatment of vesicoureteral reflux?

In endoscopic treatment of vesicoureteral reflux, or VUR, the doctor uses a special viewing device, called a cystoscope, to see inside the bladder. The cystoscope is inserted through the urethra, the opening through which urine leaves the body. Then the doctor injects a small amount of a substance, called Deflux, into the wall of the bladder near the opening of one or both ureters, the tubes that carry urine from the kidney to the bladder. This creates a bulge in the tissue, making it harder for the urine to flow back up the ureter to the kidneys. There are no incisions made in the abdomen for this procedure.

What's injected into the bladder wall?

Presently, a substance called Deflux is the only injectable material approved by the U.S. Food and Drug Administration (FDA) for this procedure; others are undergoing clinical trials and have been used in other parts of the world for many years. Deflux is a gel-like liquid made of two complex sugars, dextranomer and hyaluronic acid. These sugars aren't harmful to the body's tissues.

How does Deflux work?

The hyaluronic acid in Deflux is a chemical that naturally occurs and breaks down in the body. The dextranomer in Deflux remains and is slowly replaced by the body's own tissues, forming a little bulge. The bulge makes it harder for the urine to flow back up the ureter and to the kidney. The bulge is permanent and corrects the reflux.

What are the risks of the procedure?

It does have some potential risks. These include mild bleeding, infection and blockage of the ureter if too much substance is injected.

How successful is this procedure?

Treatment with Deflux has a higher success rate for those with lower grades of reflux. One study reported a 95 percent success rate for grade II reflux, 71 percent success rate for grade III and 43 percent success rate for grade IV reflux. Similarly, a second study reported an 87 percent success rate for grade II reflux, a 75 percent success rate for grade III and 41 percent success rate for grade IV reflux. In another study, researchers reported a 78 percent success rate for both grades II and III reflux, and 66 percent success rate for grade IV reflux.

The success of the procedure is also dependent on the individual child and the doctor's technique. Sometimes more than one treatment is needed to build up a bulge large enough to reduce the child's reflux.

Who can have this procedure?

Based on the success rates, this procedure is recommended for children with grade II, grade III, and possibly grade IV reflux. The treatment should not be used in patients who have:

  • Two kidneys that don't work at all
  • An abnormal pouch in the bladder wall
  • An extra ureter (the tube that carries urine from the kidney to the bladder)
  • Active urinary tract infection
  • Active voiding dysfunction, or abnormal emptying of bladder

What happens on the day of the procedure?

Preparation for the procedure takes about an hour, and the procedure itself takes about 30 minutes. Your child will be put to sleep with a general anesthetic for the procedure. You can be with your child as he or she recovers.

Since there are no abdominal incisions made for this procedure, your child can go home the same day.

What can we expect after the procedure?

There may be some blood in your child's urine, and your child may experience some mild pain when urinating. This is normal. However, if your child has any of the symptoms described below, call the Pediatric Urology office at (415) 353-2200 immediately:

  • Fever above 100.5° F
  • Vomiting
  • Severe pain

We will perform a follow-up kidney and bladder ultrasound a month after the procedure, and possibly a bladder scan in six months.