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Joseph Junewick, MD FACR
over 7 years ago
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Calcified Deflux

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 4 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: US FL
Activities:
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History

Female toddler with vesicoureteroreflux treated with deflux.


Case Images


Diagnosis

Calcified deflux.

Clinical Notes

Normal renal size with no hydronephrosis.

Findings

FL – Spot image from VCUG shows high grade reflux during the filling phase.

US – Follow up ultrasound examination to assess renal growth shows focal calcifications at the expected ureteral insertions in the bladder trigone.

Discussion

Deflux® is a biological implant composed of highly viscous gel of dextranomer microspheres in a carrier gel of nonanimal stabilized hyaluronic acid. The dextranomer microspheres range in size between 80 to 250 microns, with an average size of about 130 microns. The stabilized hyaluronic acid acts mainly as a carrier, leaving the dextranomer microspheres at the implant site. Deflux is a commonly used compound in the endoscopic treatment of vesico-ureteric reflux. Deflux is injected into the submucosal intraureteral space and tracks along the length of the detrusor tunnel, resulting in a coapted ureteral tunnel and decreased vesicoureteral reflux. Deflux is typically inert but can occasionally provoke inflammation and subsequently dystrophic calcification. Calcification is reported to occur in 2% of patients with a lead time of approximately 4 years. Calcified Deflux may be difficult to differentiate from distal ureteral stones especially when associated with hydronephrosis.

Reference

Yankovic F, Swartz R, Cuckow P, et al.Incidence of Deflux(®) calcification masquerading as distal ureteric calculi on ultrasound. J Pediatr Urol 2013 Dec;9(6):820-4.

Contributor

Ellen Junewick



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