Use of DEFLUX in the Management of Vesicoureteral Reflux
It is the current position of the American Urological Association that endoscopic injection of the dextranomer/hyaluronic compound Deflux® is an option in the management of pediatric vesicoureteral reflux (VUR).
The absence of inclusion of Deflux in the 1997 Pediatric Reflux Guidelines simply reflects the fact that it had not been introduced at that time and therefore could not have been evaluated. The contention that Deflux has not been proven to reduce urinary infections associated with reflux is inappropriate to the same extent that no other treatment modality has been shown to reduce all urinary tract infections. The resolution of reflux has been shown to reduce the incidence of pyelonephritis. Therefore to the extent that Deflux can correct VUR, it will reduce the incidence of pyelonephristis. The significantly lower morbidity associated with the use of Deflux, compared to open surgery, indicates Deflux must be considered as an important option in VUR management. The choice of management options remains with the informed family and the physician, based upon multiple factors including age, sex, reflux grade, voiding patterns, risk of renal injury, and parental preferences. To attempt to dictate specific treatment modality based upon concrete evidence is simply impossible based upon the current state of evidence. Any claim that current evidence can guide such a decision reflects a lack of understanding of the state of current evidence. As more evidence emerges, selection of specific therapy for specific patients may become more appropriate. At present, Deflux must be considered an option in the care of the pediatric patient with VUR.
AUA Board of Directors, October 2007