Sun, 09/12/2010 - 12:16 | by admin
Initial investigations with DEFLUX indicated that 68% of patients with VUR can expect to be cured.1 A subsequent study demonstrated a correction of reflux in 86% of treated ureters after a single DEFLUX injection.2
Published data from the Swedish Reflux Trial indicate that 86% of patients in the Deflux treatment group had their VUR resolved or downgraded (grade I-II VUR) after 1 to 2 injections.3
Deflux is highly effective at preventing febrile UTIs in children with VUR
Patients receiving Deflux experienced a significant reduction in the number of VUR-associated UTIs—nearly 4-times fewer events—compared with patients on antibiotic prophylaxis (0.08 vs 0.28) (Figure 1).5
Figure 1. Reduction in VUR-associated UTIs with Deflux5
Furthermore, surveillance was shown to be less effective than Deflux in preventing febrile UTIs (Figure 2).6
Figure 2. Febrile UTI recurrence rate by gender and treatment group6
In a published study from Baylor College of Medicine, no patients treated with Deflux suffered from postoperative febrile UTIs in a 1-year follow-up assessment. Additionally, this study recommends that physicians consider Deflux for first-line use.4
Increased success with experience
Studies have reported a learning curve associated with the DEFLUX injection procedure. This was demonstrated in one study in which 180 patients were treated for VUR using DEFLUX, 134 of whom were followed for at least three months.
Success rates increased from 60% for the first 20 patients injected, to 80% for the last 20 cases.3 Combined with refinements in the equipment used, this may account for some of the increases in cure rates reported in recent studies compared with earlier studies using the same technique.
The standard subureteric transurethral injection (STING) technique is an effective procedure, resulting in cure or improvement for the majority of children with VUR based on physician experience.
In summary, a relatively brief learning curve has been observed for subureteric injection with Deflux gel, with lower cure rates in the first few cases.4
Additionally, a study from Dr. Hsieh and colleagues concluded that, “after a learning curve…and based on a single VCUG performed shortly after surgery, VUR may be cured by endoscopic injection of HA/Dx gel [Deflux] in a large proportion of patients.”4
If a patient does not respond to the first injection procedure, repeat endoscopic injection of DEFLUX is viable. Response rates following repeat procedures were considered in an early study of DEFLUX in which patients received up to three injections. Each injection was found to have a near equal probability of producing a successful response (54% vs. 43% vs. 50% for the first, second, and third injection, respectively).1
Treating bilateral VUR with DEFLUX
A proportion of patients will suffer a degree of VUR in both ureters (bilateral VUR). Usually reflux in the more severe side prompts diagnosis and treatment, but mild reflux in the contralateral ureter may be detected by VCUG.1 In these patients, both ureters can be injected in the same treatment procedure. 3
- Läckgren G, Wåhlin N, Sköldenberg E, et al. J Urol 2001; 166: 1887-92.
- Puri P, Chertin B, Velayudham M, et al. J Urol 2003; 170: 1541-4.
- Kirsch AJ, Perez-Brayfield MR, Scherz HC. J Urol 2003; 170: 211-5.
- Hsieh MH, Madden-Fuentes RJ, Lindsay NE, Roth DR. Urology. 2010;76(1):199-203.
- Elder JS, Shah MB, Batiste LR, Eaddy M. Curr Med Res Opin. 2007;23(suppl 4):S15-S20.
- Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. J Urol. 2010;184(1):286-291.