Acute bilateral ureteric obstruction after Deflux injection: a case report

TL;DR

A child developed severe kidney blockage after a minimally invasive VUR treatment, requiring emergency intervention.

Contribution

Highlights a rare but serious complication of endoscopic bulking agent injection for vesicoureteral reflux.

Findings

Acute bilateral ureteral obstruction occurred after Deflux injection in a 7-year-old boy.

Emergency stent placement resolved the obstruction and improved hydronephrosis.

The patient remained asymptomatic for 5 years post-treatment.

Abstract

Vesicoureteral reflux (VUR) is a prevalent cause of recurrent urinary tract infections and renal scarring in pediatric patients, managed with conservative measures or surgical intervention. Endoscopic sub-ureteral bulking agent injection provides a minimally invasive option. We present a 7-year-old boy with severe bilateral VUR who developed acute bilateral ureteral obstruction following dextranomer/hyaluronic acid (Deflux) injection. Despite an unremarkable early postoperative course, he developed severe abdominal pain, vomiting, anuria, elevated creatinine, and worsening hydronephrosis. Emergency cystoscopy with bilateral double-J stent placement relieved the obstruction. Significant inflammatory masses at the uretero-vesical junction markedly improved following stent removal. The patient remained asymptomatic without hydronephrosis after 5 years. This case highlights the uncommon but significant risk of ureteral obstruction following endoscopic bulking agent injection and emphasizes the need for careful post-procedural monitoring.

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