Deflux: Treatment for Vesicoureteral Reflux

What is Deflux® procedure?

Deflux® (dextranomer/hyaluronic acid) is an injected gel that treats vesicoureteral reflux, or pee backing up from your bladder in the wrong direction. A urologist injects Deflux during cystoscopy — a minimally invasive bladder procedure — and it forms a bulge that acts like a valve. The valve allows pee to flow correctly into your bladder but prevents it from backing up into your ureters (tubes that drain pee from your kidneys).

You might hear Deflux procedures called subureteral transurethral injection (STING) or hydrodistension implantation technique (HIT).

What is Deflux injection used for?

Healthcare providers most commonly use Deflux to treat vesicoureteral reflux (VUR) in kids, but they can also use it to treat adults. Providers also sometimes use Deflux to treat urinary incontinence (leaking pee).

VUR causes pee to back up into your ureters, and sometimes all the way to your kidneys. This can cause frequent urinary tract infections (UTIs), kidney scarring and other complications. Kids can grow out of VUR, though they don’t always. Deflux can prevent urine backflow while you wait to see if the issue resolves on its own. Your own tissue also breaks down and replaces the Deflux implant over time (the implant shouldn’t lose its effectiveness as this happens).

What is Deflux made of?

Deflux is made of:

• Dextranomer, a polysaccharide (carbohydrates made up of sugar molecules) used in pharmaceuticals, including wound cleaning products.
• Hyaluronic acid gel, another polysaccharide that your body naturally makes. It’s also commonly used in cosmetics.

Your body naturally breaks down and safely absorbs the Deflux gel over time.

How do I prepare for a Deflux procedure?

Your provider will give you instructions on how to prepare for a Deflux injection. They may ask you to:

• Not eat or drink anything (fast) for a certain amount of time before the procedure.
• Not take certain medications or alter your medication schedule. Don’t stop taking medications unless your provider tells you to.
• Arrange for someone to drive you home.

Tell your healthcare provider about any medications you take, including supplements.

What happens during a Deflux injection?

To implant Deflux, a healthcare provider will:

1. Put you (or your child) under general anesthesia.
2. Numb your urethra (the tube that drains pee out of your body) with gel.
3. Slide a lubricated cystoscope (lighted tube with a camera on the end) through your urethra to your bladder.
4. Fill your bladder with saline. This can make it easier to see the inside of your bladder.
5. Place a needle through the cystoscope.
6. Inject Deflux into your bladder wall near your ureter.
7. Remove the needle and the cystoscope and drain the fluid from your bladder.

How long does the Deflux procedure take?

Placing a Deflux implant usually takes less than 30 minutes. It’s an outpatient procedure, so you won’t need to stay in the hospital afterward.

What happens after the Deflux procedure?

You (or your child) may be a little drowsy right after the procedure. You should spend the rest of the day at home, resting. Your provider may perform a follow-up voiding cystourethrogram (VCUG) to make sure the procedure was successful.

How long does Deflux last?

A Deflux implant can treat VUR for up to 25 years.

What are the potential benefits of Deflux?

Benefits of Deflux compared to other treatments include:

• Short recovery time.
• Low risk of complications.
• The polysaccharides that make up Deflux are compatible with your body, and your cells break them down safely over time.

What is the success rate of the Deflux procedure?

Studies have reported success rates between 70% and 93% for Deflux injections. Keep in mind that each study reports slightly different success rates. Generally, Deflux is more effective in treating mild (lower grade) VUR than severe VUR.

What are the risks of Deflux injections?

Risks of placing a Deflux implant include:

• Bruising and swelling.
• Bladder damage.
• Blockage of your ureter.

Sometimes, VUR and UTIs continue despite treatment. You may need additional injections if your symptoms continue after one Deflux treatment.

How long will it take for me to feel better after a Deflux injection?

You may be sore, have pain when you pee or have bladder spasms (cramping or strong urge to go to the bathroom) for a day or two after Deflux procedure. After that, you’ll be able to return to your usual activities.

What should I watch for if my child had a Deflux procedure?

Your child’s provider will tell you what to expect and when to call them in the days following a Deflux procedure. Your child might:

• Not want to pee.
• Not want to drink fluids.
• Complain of a stinging or soreness when trying to pee.
• Not be able to hold their pee or wet the bed.
• Have pink-tinged pee.

These are common reactions and should go away in a day or two. Contact their provider if these symptoms last longer. Encourage your child to drink plenty of water and make sure they’re not holding their pee for more than eight hours at a time.

When should I call my healthcare provider?

Call the provider that performed the Deflux procedure if you or your child experiences any of these symptoms:

• Inability to pee or refusal to pee.
• Hasn’t peed in eight to 10 hours.
• Pain when peeing more than two days after the procedure.
• Severe belly, back or side pain.
• Fever higher than 101.5 degrees Fahrenheit (38.6 degrees Celsius).
• Worsening bladder spasms that don’t go away within 24 hours.
• Frequent vomiting.
• Back or hip pain.

A note from Cleveland Clinic

Vesicoureteral reflux can cause frequent infections from pee backing up into your ureters. If your child has VUR, you may wonder what the best treatment options are. A urologist may suggest a Deflux injection. Deflux injections are safe and minimally invasive, but their effectiveness can vary. They might not work as well if you or your child has severe VUR. Ask your healthcare provider about the benefits and risks of any procedure. They can tell you what your options are and help you choose the right treatment for your specific situation.