Deflux and Botulinum Toxin Type A as Combined Therapeutic Approach in Pediatric Vesicoureteral Reflux and Concurrent Non‐Neurogenic Dysfunctional Voiding: Insights From a Prospective Single‐Arm Study
Negar Mohammadi Ganjaroudi, Negin Jarrah, Parmida Sadat Pezeshki, Shervin Tavakoli, Abdol‐Mohammad KajbafzadehABSTRACT
Purpose
We aimed to assess uroflowmetric measurements and quality‐of‐life outcomes following synchronous Deflux injection and pelvic floor and inter‐sphincteric Botulinum toxin type A (BTX‐A) injection in pediatric patients diagnosed with vesicoureteral reflux (VUR) and non‐neurogenic dysfunctional voiding (NNDV) at 6‐month and 1‐year follow‐ups.
Methods
This prospective study included female children aged 5–18 years with concurrent VUR and NNDV. All participants underwent pre‐and postoperative ultrasonography, uroflowmetry study and quality‐of‐life assessment. Deflux injection was performed using the hydrodistension implantation technique in the refluxing ureter. BTX‐A injection was administered to the periurethral and perineal body areas. Participants with functional constipation, confirmed by ROME Ⅳ criteria, received perianal BTX‐A injection. All statistical analyses were conducted using R Statistical software (version 4.4.2), with a significance threshold set at p < 0.05.
Results
Among 30 patients, near bell‐shaped voiding patterns were observed in 23 (76.7%) at 6‐month and 27 (90%) at 1‐year follow‐ups with a significant overall change across three assessment timepoints (LR = 37.47, p < 0.001). Complete VUR resolution was observed in 40 of 46 (87%) refluxing renal units at 6 months ( p < 0.001). Volume‐adjusted maximal and average flow indices improved significantly over time ( p = 0.003 and p < 0.001, respectively). PinQ scores decreased from 20.83 ± 8.55 preoperatively to 11.26 ± 6.91 at 1‐year follow‐up ( p < 0.001).
Conclusion
This prospective study indicated that the combined BTX‐A and Deflux injections were associated with improvements in dysfunctional voiding severity, voiding flow parameters, voiding diaries, and quality‐of‐life outcomes in children with concurrent NNDV and VUR.