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Pseudodistal ureteral stone resulting from calcified Deflux implantation

Anthony J Polcari1, Dae Y Kim, Brian T Helfand

  • 1Department of Pediatric Urology, Children's Memorial Hospital, Chicago, IL 60614, USA.

Urology
|July 21, 2009
PubMed

Insights

Subureteral endoscopic injection of dextranomer/hyaluronic acid (Deflux) can cause microcalcification in the bladder wall. This calcified implant was mistaken for a ureteral stone in a pediatric patient presenting with abdominal pain.

Area of Science:

  • Pediatric Urology
  • Minimally Invasive Surgery
  • Biomaterials Science

Background:

  • Vesicoureteral reflux (VUR) affects 1% of pediatric patients.
  • Subureteral endoscopic injection of dextranomer/hyaluronic acid (Deflux) is a popular minimally invasive VUR treatment.
  • Histologic studies indicate Deflux implants may develop microcalcification.

Observation:

  • A 12-year-old girl with VUR treated with Deflux presented with abdominal pain.
  • Imaging revealed a hyperdense bladder wall mass, initially suspected as a distal ureteral stone.
  • Cystoscopy and retrograde pyelography confirmed the mass was an intramural Deflux deposit.

Findings:

  • This case highlights the potential for calcified Deflux implants to mimic ureteral stones on imaging.
  • It is the second reported instance of this diagnostic confusion in a symptomatic patient.
  • Microcalcification of Deflux implants is an identified, albeit infrequent, complication.

Implications:

  • Radiologists and urologists should consider calcified Deflux implants in the differential diagnosis of bladder wall masses in patients with a history of VUR treatment.
  • Accurate diagnosis prevents unnecessary invasive procedures for suspected ureteral stones.
  • Further research into the long-term behavior and imaging characteristics of Deflux implants is warranted.

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