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 two of three: a (b)(6) patient with documented but treated bladder-bowel dysfunction, bilateral vcug grade:4, left kidney hydronephrosis grade 1 and right kidney dmsa: 63%df was treated with double hit deflux injection.During intraoperative observations the surgeon noticed uo (ureteral orifice) gaping and lateral.Patient developed right kidney grade 4 hun with dmsa: 27% after 52 months and was treated with open ureteral re-implantation with extravesical dissection.
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