Endoscopic Injection (Deflux) Aftercare and Follow-up

Endoscopic injection is performed under general anesthesia using a thin camera (cystoscope) passed through the urinary tract; there is no skin incision, and the procedure usually takes 15–30 minutes. Once the child wakes from anesthesia, starts taking fluids, and passes urine, they are usually discharged the same day.

In the first 1–3 days, mild burning with urination, a frequent urge to urinate, and pink or lightly blood-tinged urine are expected findings. These are related to the cystoscope passing through the urinary tract and the injection made at the ureteral opening; they resolve on their own within a few days.

• Fluids: slightly more than the age-appropriate amount, water spread through the day.
• Pain relief: paracetamol at regular intervals, usually enough for the first 24–48 hours.
• Activity: normal daily life the next day; return to school or daycare within 1–2 days; wait 3–5 days for the pool or sea.
• Bathing: a shower is fine the same evening; there is no incision, so no wound care is needed.

In a child who was on antibiotic prophylaxis (CAP) before the procedure, the medication is not stopped immediately afterward; the general approach is to continue it until the follow-up study shows the reflux has resolved. This protects the child during the early months while the bulking agent settles and the swelling at the injection site subsides.

A kidney-bladder ultrasound is performed approximately 4–6 weeks after the procedure. The aim is to see whether the bulking agent placed at the ureteral opening has narrowed the ureter (obstruction); this is reported in the literature as a rare occurrence, under 1%, but is easily managed when caught early.

Only a voiding study can show whether the injection has corrected the reflux; ultrasound does not show reflux. For this reason, most centers perform a VCUG (voiding cystourethrogram; informally, the “catheter film”) or its radiation-free alternative, ceVUS (contrast-enhanced voiding urosonography), 3–6 months after the procedure; the timing varies by center.

If any of the following findings occur, call your team without waiting for the scheduled follow-up date; if fever and flank pain occur together, same-day evaluation is needed.

• Fever of 38°C or higher, especially with chills or flank/abdominal pain.
• Inability to urinate, or urinating in drops with straining; no urination for more than 6–8 hours.
• Blood-tinged urine or passing clots that persists or increases after day 3.
• Severe, unrelenting flank pain or repeated vomiting (concerning for obstruction).
• In infants: poor feeding, vomiting, excessive fussiness, or lethargy.
• Burning and frequent urination lasting more than 3–5 days (a urine culture is needed).