Pseudodistal Ureteral Stone Resulting From Calcified Deflux Implantation

Vesicoureteral reflux (VUR) is a common clinical problem affecting 1% of pediatric patients. Subureteral endoscopic injection of dextranomer/hyaluronic acid (Deflux) is a minimally invasive treatment option for VUR that is rapidly gaining popularity. Histologic studies have demonstrated that in a minority of patients, the Deflux injection site can be associated with microcalcification. We report the case of a 12-year-old girl with a history of VUR who had previously been treated with Deflux and presented with abdominal pain and was noted to have a small hyperdense mass in the bladder wall on imaging. The presumptive diagnosis of a distal ureteral stone was ultimately ruled out by cystoscopy and retrograde pyelography, which revealed that the lesion seen on imaging represented the intramural Deflux deposit. This is the second reported case in which a calcified Deflux implant was mistaken for a distal ureteral stone in a patient presenting with abdominal pain.