[Vesico-ureteral-renal reflux in adults: an overview]

From 1970 to 1980 forty-four ureters with vesico-ureteral-renal (VUR) reflux were treated surgically at the University Urologic Clinic, Inselspital, Berne. According to Hodson's classification, four patients were grade 1, 23 grade 2 and 17 grade 3. Distribution of the renal lesions by Smellie's classification was 4 without renal lesion, 24 with grades 1 and 2, and 16 in grade 3 and 4. Comparison of the results of these two classifications shows that the higher the degree of reflux, the more severe the renal lesions. In over 70% of cases the ostia were malpositioned and stadium, horseshoe or golf hole-shaped. Our surgical indication is based on the type of reflux, the renal lesions, localization of the ostia, peaking fever linked to clinical finding of pain in the seat of the kidney and micturitional disorders. Uretero-cysto-neostomy by the Politano-Leadbetter technic was performed 35 times, by that of Paquin 5 times, by that of Cohen twice and by that of Lich-Grégoire twice. Despite 90% surgical success, we have observed that chronic pyelonephritis continues to exist and that the improvement produced by surgery is chiefly a clinical one, in the form of elimination of the fever pain episodes.