Vesico-ureteral reflux in non-paediatric patients

In the period 1968-1975 we treated 55 female and 19 male adolescent or adult patients for vesico-ureteral reflux (v. u. r.) to a total of 116 renal units. The reflux was primary in 69 units, secondary in 20 and or mixed type in 27 units. It was of moderate degree in 50 units, 31 (62%) of which showed radiologic nephropathy. Of the 18 units with gross reflux, 16 (89%) showed nephropathy. Re-implantation of 75 ureters in the bladder ad modum Politano-Leadbetter was followed by cessation of reflux in 66 units (88%), with cure of symptoms and bacteriuria in a corresponding number of patients. Infravesical surgery or antibacterial medication were less effective when used alone. Two patients with severely impaired renal function (serum creatinine greater than 440 mumol/l) failed to improve, despite technically successful surgery. Primary v. u. r. in adolescents and adults has often been present since childhood, and many of these patients show radiologic evidence of nephropathy. Effective antireflux treatment should be given early, in order to prevent progressive renal damage.