Delayed Ureteral Obstruction After Deflux^® Injection for Vesicoureteral Reflux: A Case Report

Abstract

In a 7-year-old patient with bilateral vesicoureteral reflux (VUR), Deflux^® was administered by intraluminal submucosal injection into bilateral ureters using the double hydrodistension implantation technique (double HIT) at the age of one year. In the early postoperative period following Deflux^® injection, there was no evidence of hydronephrosis. One year after the procedure, the reflux had disappeared. However, at the age of six years, the patient developed a febrile urinary tract infection. Following radiological investigations, hydronephrosis of grade 4 according to the Society of Fetal Urology (SFU) classification was detected on the left side. We diagnosed the patient as having delayed ureteral obstruction following Deflux^® injection. At the age of seven years, a left ureteral stent was placed and left ureteroneocystostomy was performed. During the procedure, ureteral obstruction at the junction of the left ureter and bladder and a high degree of adhesion of the left ureter to the dorsal side of the bladder were observed. Hence, adhesiolysis of the left ureter was performed via intravesical and extravesical approaches. The reason for the sequelae in this case is presumed to be the injection of Deflux^® into an incorrect layer and/or the occurrence of chronic inflammation due to a foreign body reaction. Long-term follow-up using ultrasonography after Deflux^® injection is necessary for the early detection of delayed ureteral obstruction.