Literature article "delayed obstruction with asymptomatic loss of renal function after dextranomer/hyaluronic acid copolymer (deflux) injection for vesicoureteral reflux: a close look at a disturbing outcome" by dimitri papagiannopoulos, ilina rosoklija, earl cheng, elizabeth yerkes, reports: "three cases where deflux was used in off-label fashion, resulting in delayed ureteral obstruction and loss of renal function (range 18-52 months post-operatively).We now place increased emphasis on the need for long-term follow-up after deflux in both routine and complex cases, particularly in situations of off-label use." case three of three: a (b)(6) patient with recurrent bladder and bowel dysfunction (bbd) was treated with double hit deflux injection.During intraoperative observations the surgeon noticed uo (ureteral orifice) off trigone laterally.Patient developed right flank pain after 45 months.Left kidney ultra sonograpphy showed gr 4 hun and mag3: 43->13% df.Patient was treated with open ureteral re-implantation with extravesical dissection.
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