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Joseph Junewick, MD FACR
over 7 years ago
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Deflux Implant

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US CT
Activities:
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History

10 year old with abdominal pain and recent endoscopic anti-reflux procedure.


Case Images


Diagnosis

Deflux Implants

Findings

US – rounded uniformly hyperechoic submucosal mounds at the trigone of the urinary bladder.

CT – US abnormalities correspond to fluid attenuation lesions.

Discussion

Vesicoureteral reflux occurs when the ureteral orifice is more laterally positioned, leading to a altered submucosal tunnel. The ratio of the length of the submucosal tunnel to the diameter of the ureteral orifice determines the liklihood of reflux; the smaller the ratio, the more likely reflux will occur.

Treatment of vesicoureteral reflux is suppressive antiobiosis with escalation to ureteral reimplantation. Deflux is an intermediate treatment option. Short term results for Deflux is fairly good ranging between 59% and 95% per ureter. The long term results are not well documented.

Deflux is dextran microspheres suspended in hyaluronic acid gel. Deflux is injected near the ureteral orifice at endoscopy. On sonography, Deflux appears as uniformly hyperechoic mounds at the bladder base. On CT, Deflux is fluid density; occasionally it can calcify and create confusion with ureterocele and distal ureteral stone. On MRI, Deflux is bright on T2 but not visible on T1, post-gadolinium T1 or MR urography.

Reference

Cerwinka WH, Grattan-Smith JD, Scherz HC, Kirsch AJ. Appearance of Deflux implants with MRI after endoscopic treatment of vesicoureteral reflux in children. J Ped Urol 2009; 5(2):114-118.

Cooper CS. Diagnosis and management of vesicoureteral reflux in children. Nature Review/Urology 2009 Macmillan Publishers Limited.



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