Is Deflux the solution for Vesicoureteral Reflux (VUR)?
VUR is the most common congenital urologic condition associated with urinary tract infections (UTI) in children. Deflux (dextranomer/hyaluronic acid copolymer) was developed in Sweden and was FDA approved for domestic use in 2001. The availability of encoscopic therapy (ET) has transformed the treatment of VUR but debate continues. “Fix it and forget it,” is said to be a major advantage. Many advocate that all children ...more »
VUR is the most common congenital urologic condition associated with urinary tract infections (UTI) in children. Deflux (dextranomer/hyaluronic acid copolymer) was developed in Sweden and was FDA approved for domestic use in 2001. The availability of encoscopic therapy (ET) has transformed the treatment of VUR but debate continues. “Fix it and forget it,” is said to be a major advantage. Many advocate that all children upon diagnosis undergo ET, as this would eliminate the need for long term prophylaxis, repetitive uncomfortable studies and open surgery. Compliance with medicine taking would not be an issue. But the role of Deflux in the treatment of children is not fully defined, therefore, and remains controversial. Some use this as first line therapy immediately after diagnosis, while others might suggest its usage only after a failure of prophylaxis or persistence of VUR. Reports are now emerging questioning the durability of Deflux and, therefore, its clinical use. Initial reports from Sweden showed that 10% of children cured of reflux would be found to reflux again 1 to 5 years after treatment. More recently, up to 15% of children successfully treated have returned with recurrent pyelonephritis and documented new renal scarring. In the Deflux arm of the Swedish Reflux Study 20% of those in whom VUR was cured had pyelonephritis and VUR reappear during the 2 year observation period. Families and clinicians may not be able to “forget it” after all. Even though further treatment of VUR may be averted in some by the early use of Deflux, cost remains a factor. One cc of Deflux costs $1,800 dollars. Up to 2 cc’s per ureter may be needed with the newer HIT technique. The surgical, anesthetic, hospital and lab fees and post-operative radiographs are in addition. 14,500 cc’s of Deflux were provided to hospitals in 2009, at a cost of over $26,000,000. If we conservatively assume that 4,000 children underwent treatment at an additional cost of approximately $10,000 each, a total of $66,000,000 were spent in 2009 on this procedure.
Therefore, significant questions regarding Deflux’s role and durability remain. A prospective, multi-institutional trial is needed.
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