Vesicoureteral reflux in the adult. V. Unilateral disease

We studied 37 patients with primary unilateral vesicoureteral reflux to compare medical (17) and surgical (20) management. Medical management consisted of observation and antimicrobial therapy as needed. During followup (mean 84.6 months) none of the patients in either management group had a significant decrease in total renal function, worsening of hypertension or progression of stone disease. The surgically treated group had a higher incidence of pyelonephritis preoperatively (75% versus 13%) but during followup these infections developed in only 10% of the surgical patients and in 13% of the medically managed group. The primary indication for surgical correction of unilateral reflux in adults is a history of pyelonephritis in patients in whom antibiotic prophylaxis has been unsuccessful or in women of childbearing age.