Primary Vesico‐ureteric Reflux in Adults

SUMMARY AND CONCLUSIONS A retrospective study of 61 adult patients with primary reflux is reported. The presentation, clinical findings, investigations, treatment and follow up are discussed and the following conclusions have been made. Primary reflux probably occurs more often in adult life than has been previously suggested. Primary reflux in adults occurs more often in women than in men. The diagnosis is made mainly in the third and fourth decades. The onset of symptoms is commonly 10 to 20 years before the diagnosis. A urinary infection or a history of infection is almost always present. The pathology of reflux in adults is similar to the pathology in children. The occurrence of this condition in adult life may be explained either as a recurrence of reflux or that a normal or only marginally competent valve becomes incompetent due to infection. At the time of diagnosis more than one third of the kidneys showed no function on i.v.p. Ureteronephrectomy was the usual treatment in these cases. If nephrectomy only is done reflux into the ureteric stump will persist and may be associated with recurrent infection. Most of the patients were treated successfully by conservative methods; the results from treating a small group by antireflux procedures was inconclusive. Reflux will be diagnosed more often only if micturating cystography is performed more frequently. Patients with pyelonephritis, small or contracted kidneys, malformations, and recurrent urinary infections and bladder symptoms are recommended for this investigation.