Incidence of Deflux Ò calcification masquerading as distal ureteric calculi on ultrasound Francisca Yankovic a , Robert Swartz d , Peter Cuckow a , Melanie Hiorns b , Stephen D. Marks c , Abraham Cherian a , Imran Mushtaq a , Patrick Duffy a , Naima Smeulders a, * a Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK b Department of Paediatric Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK c Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK d Department of Urology, Orebro University Hospital, Orebro, Sweden Received 10 September 2012; accepted 31 October 2012 Available online 24 November 2012 KEYWORDS Dextranomer- hyaluronic acid; Deflux Ò ; Calcification; Ureteric calculus; Ultrasound Abstract Objective: Dextranomer-hyaluronic acid (Deflux Ò ), the most widely used compound in the endoscopic treatment of vesico-ureteric reflux (VUR) today, is believed to provoke only minimal inflammation. Reports of calcification of Deflux Ò are increasing. We ascertain the inci- dence of Deflux Ò calcification appearing as distal ureteric calculi on ultrasound. Methods: Three cases (2 external patients) of ureteroscopy for calcified submucosal Deflux Ò prompted a retrospective review of the notes and imaging of all children treated with Deflux Ò for VUR between December 2000 and January 2011 at Great Ormond Street Hospital. Results: 232 children (M:F Z 5:3) received Deflux Ò for VUR at median age 2 years (range 2 monthse12 years). Follow-up annual ultrasound, performed in all, identified calcification in 2. The interval between Deflux Ò injection and presentation of its calcification was 4 years. 104 of the 232 children had been followed up for 4e10 years. Considering the observed lag- period, after 4 years the incidence of calcification of Deflux Ò on ultrasound was 2% (2/104). * Corresponding author. Tel.: þ44 20 74059200; fax: þ44 20 78138260. E-mail addresses: Francisca.yankovic@gosh.nhs.uk (F. Yankovic), Robert.swatrz@orebroll.se (R. Swartz), Peter.cuckow@gosh.nhs.uk (P. Cuckow), Melanie.hiorns@gosh.nhs.uk (M. Hiorns), Stephen.marks@gosh.nhs.uk (S.D. Marks), Abraham.cherian@gosh.nhs.uk (A. Cherian), Imran.mushtaq@gosh.nhs.uk (I. Mushtaq), pgduffy@doctors.org.uk (P. Duffy), naima.smeulders@gosh.nhs.uk (N. Smeulders). 1477-5131/$36 ª 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jpurol.2012.10.025 Journal of Pediatric Urology (2013) 9, 820e824