Deflux® injection

What is Deflux® injection?

Deflux® is a treatment for vesicoureteral reflux (VUR), a condition in which urine flows back upwards from the bladder towards the kidneys. It comes in the form of an injection, and prevents urine from passing back up the ureters (the tubes that carry urine from the kidneys to the bladder). Deflux® is sometimes referred to as the STING procedure, in reference to the previously used injection it replaced.

Why is it done?

In children with VUR, the valves at the bottom of the ureters (the tubes draining the urine from the kidney to the bladder) do not close properly, allowing urine to reflux back up the ureters. Patients can be managed by a small dose of an antibiotic that they take every evening.

However, some children will still present with urinary tract infections with symptoms like fever, loss of appetite, vomiting, tummy pain, and pain on passing urine. These are called break-through infections. If infected urine refluxes up the ureters (the tubes normally draining the urine from the kidneys to the bladder) to the kidneys, it can damage them and lead to scarring in the kidney and loss of function.

What does it involve?

A cystoscope (a camera to look in the bladder) is used and Deflux is injected in the wall of the bottom of the ureter. As Deflux is a bulking agent, the injection causes increased tissue bulk where the ureter drains into the bladder and creates a valve-like mechanism that prevents urine to reflux up the ureter. The wideopen ureteric orifice becomes a slit-like orifice and urine does not flow upwards anymore.

How do you prepare for a Deflux® injection?

The procedure is performed as day surgery and happens under general anaesthesia. You will be able to go home the same day. The hospital will send you a letter with all information regarding timing of when you should stop eating and drinking. Your child will be given antibiotics at the beginning of the surgery. The procedure will take about 30 minutes. There will be minimal pain relief required afterwards and your child will be able to drink and eat shortly after the intervention.

Aftercare

Your doctor will likely continue the antibiotic prophylaxis for a while and will organise a follow-up kidney and bladder ultrasound and a follow-up appointment after. If your child presents with fever and/or pain during passing urine, this might be a sign of a urinary tract infection and you need to go to A&E.

Alternatives to this treatment

Endoscopic treatment of VUR is the least invasive way of surgical treatment if medicine alone does not work. It can be repeated if necessary. Some children, however, will require more invasive surgery to deal with ongoing reflux and infections.