AB177. SOH26AB_0055. Long-term outcomes of Deflux injection for vesicoureteral reflux: a systematic review

Background: Deflux (dextranomer/hyaluronic acid) injection has become an established minimally invasive treatment for vesicoureteral reflux (VUR), yet long-term effectiveness and complication rates remain variably reported. Key outcomes of interest include hydronephrosis, recurrent urinary tract infections (UTIs), pain, need for surgical re-implantation, and the influence of bladder and bowel dysfunction (BBD).

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across MEDLINE, Embase, Scopus, and Cochrane databases. Eligible studies included prospective or retrospective cohorts, randomized trials, or long-term follow-up series reporting outcomes at ≥2 years post-Deflux injection. Data extracted included patient demographics, reflux grade, injection technique, radiographic outcomes, symptomatic improvement, and secondary interventions. Primary outcomes were radiologic resolution of VUR, hydronephrosis development, recurrent UTIs, chronic pain, and re-operation rates. Secondary analysis assessed outcomes in children with BBD.

Results: Across included studies, Deflux demonstrated durable VUR resolution in a significant proportion of patients, with reported long-term success rates ranging from 60% to 85% after one or more injections. Hydronephrosis was uncommon and typically transient, with true obstruction rare. Recurrent UTIs decreased markedly post-treatment, though children with persistent or recurrent reflux remained at higher risk. Pain was infrequent and generally self-limited. Approximately 10–20% of patients required subsequent surgical re-implantation, most often due to persistent high-grade reflux. BBD emerged as a notable negative predictor of success, with lower resolution rates, higher recurrence of UTIs, and increased likelihood of secondary procedures.

Conclusions: Deflux injection remains an effective long-term option for many children with VUR, with low complication rates. However, outcomes are significantly influenced by underlying BBD, highlighting the importance of integrated bladder management to optimize durability and reduce the need for re-intervention.

Keywords: Deflux (dextranomer/hyaluronic acid); hydronephrosis; urinary tract infection (UTI); re-implantation; vesicoureteral reflux (VUR)