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Follow-up demonstrated marked VUR severity reduction, fewer recurrent UTIs, and resolution of chronic flank pain, supporting this minimally invasive approach for adult symptomatic reflux after reimplantation.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/deflux-as-a-minimally-invasive-solution-for-vesicoureteral-reflux-following-ureteral-reimplantation/460415/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/deflux-as-a-minimally-invasive-solution-for-vesicoureteral-reflux-following-ureteral-reimplantation/460415.png","ImageObject",300,407,{"name":42,"@type":43},"dawugda","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":33},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What condition did the patient have after ureteral reimplantation?","Question",{"text":62,"@type":63},"She had Grade 4 vesicoureteral reflux associated with recurrent UTIs and right-sided pyelonephritis, along with hydroureteronephrosis and cortical scarring.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Why was Deflux considered for this adult case?",{"text":67,"@type":63},"Deflux is a minimally invasive endoscopic bulking-agent injection that can correct reflux at the ureterovesical junction, offering an alternative to more invasive surgical revision.",{"name":69,"@type":60,"acceptedAnswer":70},"What were the outcomes after Deflux injection?",{"text":71,"@type":63},"Posttreatment results showed reduced VUR severity, decreased recurrent UTIs, and resolution of chronic flank pain, with no immediate postoperative complications 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Following Ureteral Reimplantation  \nYaniv Maddahi, Amna Jan1, Vanessa Reese2, Zachariah G Goldsmith3  \nLewis Katz School of Medicine, Temple University, Departments of 2Research and Innovation and 3Urology, St. Luke’s University Health Network, Bethlehem, PA,  \n1Barnard College, Columbia University, New York, NY, USA  \nAbstract  \nA middle‑aged female with a history ofiatrogenic right ureteral injury and surgical reimplantation was referred to our clinic for recurrent urinary tract infection (UTI) with right‑sided pyelonephritis and fever. The workup revealed Grade 4 vesicoureteral reflux (VUR) on cystogram and moderate hydroureteronephrosis with cortical scarring on computed tomography. She was offered surgical repair versus attempted minimally invasive endoscopic treatment. The patient elected for endoscopic treatment with a hyaluronic acid copolymer (Deflux), a bulking agent typically used to treat VUR in children. Posttreatment results showed a significant reduction in VUR severity, reduction of her recurrent UTIs, and resolution of chronic flank pain. This case report demonstrates a successful utilization of this approach for symptomatic reflux following ureteral reimplantation in an adult.  \nKeywords: Deflux, ureteral injury, vesicoureteral reflux  \nIntroductIon  \nVesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the ureters and, potentially, the kidneys. [1] Left untreated, this leads to renal injury and urinary tract infections (UTI) . VUR is more common in infants and children due to congenital or acquired causes. [2] VUR in adults from iatrogenic ureteral injury is rare. Treatment of VUR from iatrogenic injury typically involves surgical repair and stenting. Deflux, cystoscopic injection of dextranomer gel (with or without hyaluronic acid) into the ureterovesical junction, is a minimally invasive alternative used to treat pediatric VUR. [3] We present a case of a middle‑aged female with iatrogenic VUR successfully treated with Deflux.  \ncase report  \nA 57‑year‑old female presented with a several‑year history of febrile UTIs, shaking chills, and recurrent pyelonephritis, occurring every 2 months. Her past medical and surgical history was significant for ureteraltransection andreimplantation from hysterectomy for uterine fibroids at an outside institution 11 years prior. Clinical workup revealed chronic right‑sided  \n\n| Access this article online |  |\n| --- | --- |\n| Quick Response Code:\u003Cbr>| Website:\u003Cbr>[https://journals.lww.com/onlinejets](https://journals.lww.com/onlinejets) |\n|  | DOI:\u003Cbr>10.4103/jets.jets_ 145_24 |\n\nhydroureteronephrosis [Figure 1], progressive renal atrophy, and recurrent pyelonephritis. A Lasix renal scan showed decreased right kidney function (33%/67% split function) without obstruction.  \nHer condition stemmed from an iatrogenic right ureteral injury during a total hysterectomy due to painful fibroids. This was managed with a prior ureteroneocystostomy. This history raised concerns about ureteral stricture or VURas a possible causes of her symptoms. Further evaluation through cystoscopy revealed a patulous reimplanted right ureteral orifice, while a cystogram confirmed Grade 4 VUR [Figure 1], with contrast refluxing up to the renal pelvis and calyces. The ureter was mildly tortuous, with dilated calyces. Ureteroscopy showed no evidence of ureteral stricture or mass, confirming VUR as the cause of her recurrent UTIs and renal dysfunction.  \nAddress for correspondence: Dr. Zachariah G Goldsmith,  \nDepartment of Urology, St. Luke’s University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.  \nE‑mail: [zachariah.goldsmith@sluhn.org](zachariah.goldsmith@sluhn.org)  \nThis is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the","cbCaidwRymAamKMf","https://ap.wps.com/l/cbCaidwRymAamKMf","pdf",681393,"English","# Abstract\n# Introduction\n# Case Report\n## Presentation and Workup\n## Evaluation and Diagnosis\n## Treatment and Procedure\n# Figures and Outcomes","[{\"question\":\"What condition did the patient have after ureteral reimplantation?\",\"answer\":\"She had Grade 4 vesicoureteral reflux associated with recurrent UTIs and right-sided pyelonephritis, along with hydroureteronephrosis and cortical scarring.\"},{\"question\":\"Why was Deflux considered for this adult case?\",\"answer\":\"Deflux is a minimally invasive endoscopic bulking-agent injection that can correct reflux at the ureterovesical junction, offering an alternative to more invasive surgical revision.\"},{\"question\":\"What were the outcomes after Deflux injection?\",\"answer\":\"Posttreatment results showed reduced VUR severity, decreased recurrent UTIs, and resolution of chronic flank pain, with no immediate postoperative complications reported.\"}]","Deflux as a Minimally Invasive Solution for Vesicoureteral Reflux Following Ureteral Reimplantation | PDF"]