Short- and long-term outcomes of Deflux injection versus ureteral reimplantation in pediatric vesicoureteral reflux: a narrative review

Vesicoureteral reflux (VUR) is a common urologic disorder associated with recurrent febrile urinary tract infections (UTIs), pyelonephritis, and renal scarring. For children who require intervention, endoscopic injections of dextranomer/hyaluronic acid copolymer (Deflux) and ureteral implantation are the two options. This narrative review employed a structured search of PubMed/MEDLINE, Scopus, and Embase to identify guideline documents, systematic reviews, and original studies with long-term follow-up, comparing these two approaches. The outcomes include radiographic reflux resolution, durability, febrile UTI recurrence, renal outcomes, complications, retreatment, recovery, cost, and quality of life. Evidence states that ureteral reimplantation provides the highest one-procedure radiographic success, and the most durable anatomical correction, especially in high-grade reflux and complex anatomy. Deflux is though less invasive, outpatient alternative with shorter recovery, and low perioperative morbidity, and lower initial treatment burden, but repeat injections, and late radiographic recurrence are more frequent. Both interventions reduce febrile UTI with favorable renal outcomes in most children, if reflux is controlled. Bladder and bowel dysfunction, reflux grade, renal scarring, anatomic complexity, previous treatment, and family preferences should guide the treatment. Deflux is favored over ureteral reimplantation for lower-risk children and families prioritizing minimal invasiveness, whereas ureteral reimplantation remains the more definitive treatment option for high-grade reflux, or where endoscopic therapy failed. Therefore, comparative studies with standardized long-term reporting are needed to refine patient selection.