Vesicoureteral reflux in the adult. I. Factors in pathogenesis

The morphologic and functional findings in 67 adults with primary bilateral vesicoureteral reflux were analyzed. A significant correlation was found between the severity of vesicoureteral reflux and the extent of renal scarring but the position and shape of the ureteral orifices did not influence the degree of reflux or scarring. Large bladder capacity was a common finding, especially in patients with residual urine or with renal insufficiency. However, bladder capacity did not correlate with the grade of vesicoureteral reflux. Patient age at the time of the first recognized urinary tract infection, and the frequency and pattern of subsequent infections did not have any influence on the severity of the renal scarring. The interpretation of these findings in the light of the current hypotheses on the pathogenesis of reflux nephropathy is discussed.