Acute bilateral ureteric obstruction after Deflux injection: a case report

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.