Practice patterns among pediatric urologists in the use of Deflux® for vesicoureteral reflux: A survey

Objectives: This study aims to assess pediatric urology practice patterns and factors which influence the use of Deflux® in the management of vesicoureteral reflux among pediatric urologists. Methods: A 11-question survey was sent out to 476 pediatric urologists who are members of the Society for Pediatric Urology. Results: 23.7% of pediatric urologists use Deflux® as first line therapy for Grade III reflux or higher. The presence of renal scarring is not a deterrent to the use of Deflux®. 17.7% would use Deflux® before a trial of observation with or without chemoprophylaxis. In children who are on observation, 20.3% would perform Deflux® when they are at an age considered appropriate for surgery as opposed to continued observation. The majority of pediatric urologists cite Deflux® success rates of >70% to >80% for Grades II-III and >50% to >60% for Grades IV-V. 23.3% of respondents indicated that new evidence citing low long-term success rates at one year decreased their use of Deflux®. 59.8% of respondents indicated they would perform a second injection after an initial failure. Ultrasound and VCUG are used as follow-up in 86.9% and 65.4% respectively after Deflux®; the majority are performed within the first 3 months, rarely at one year. Conclusion: The use of Deflux® is growing and whether it surpasses open reimplantation and chemoprophylaxis as first-line therapy remains to be seen. With new literature showing lower success rates, long-term follow-up with repeat imaging may be required.