Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction treated with dextranomer/ hyaluronic acid copolymer (Deflux) Jason P. Van Batavia, Shannon N. Nees, Angela M. Fast, Andrew J. Combs, Kenneth I. Glassberg* Division of Pediatric Urology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA Received 30 June 2013; accepted 16 October 2013 KEYWORDS Vesicoureteral reflux; Lower urinary tract conditions; Deflux; Dysfunctional voiding; Pediatrics Abstract Objective: There has been hesitancy to use dextranomer/hyaluronic acid copol- ymer (DHXA, Deflux for vesicoureteral reflux (VUR) in the setting of lower urinary tract (LUT) dysfunction because of the limited number of published studies, the possibility of less success, and the manufacturer’s recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients whose VUR persisted despite targeted therapy for their LUT condition. Materials and methods: We reviewed patients diagnosed with both a LUT condition and VUR who underwent subureteric DXHA while still undergoing treatment for their LUT dysfunction. Persistence of VUR was confirmed by videourodynamic studies (VUDS)/VCUG (voiding cystour- ethrogram) and all patients were on targeted treatment (TT) and antibiotic prophylaxis prior to and during DXHA injection. VUR was reassessed post-injection. Results: Fifteen patients (22 ureters; 21F,1M) met inclusion criteria (mean age 6.1 years, range 4e12). Following one to three DXHA injections, VUR resolved in 17 ureters (77%) including eight of nine ureters in dysfunctional voiding (DV) patients, five of nine in idiopathic detrusor over- activity disorder (IDOD), and four of four in detrusor underutilization disorder (DUD) patients. Conclusions: DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection. ª 2013 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company. * Corresponding author. Tel.: þ1 212 305 9918; fax: þ1 212 342 1065. E-mail addresses: jpv2107@columbia.edu (J.P. Van Batavia), kglassberg@aol.com (K.I. Glassberg). + MODEL Please cite this article in press as: Van Batavia JP, et al., Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction treated with dextranomer/hyaluronic acid copolymer (Deflux), Journal of Pediatric Urology (2013), http://dx.doi.org/ 10.1016/j.jpurol.2013.10.017 1477-5131/$36 ª 2013 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company. http://dx.doi.org/10.1016/j.jpurol.2013.10.017 Journal of Pediatric Urology (2013) xx,1e6