Conservative treatment and anti-reflux surgery in adults with vesico-ureteral reflux: effect on urinary-tract infections, renal function and loin pain in a long-term follow-up study

Study purpose. To investigate the long-term effects in adults of conservati ve treatment and anti-reflux surgery for vesico-ureteral reflux on urinary- tract infections, renal function, and loin pain. Methods. Of 115 adult patients with vesico-ureteral reflux diagnosed betwee n 1968 and 1984, conservative treatment was given to 46 patients (36 women) and anti-reflux surgery was performed in 57 patients (52 women). The remai ning 12 patients underwent nephrectomy or heminephrectomy and were excluded from the study. The anti-reflux surgical methods used were the Politano-Le adbetter procedure in 44 patients (73 ureters) and the Hutch procedure in 1 9 patients (25 ureters). Six of these patients were operated on with both m ethods. Results. The frequency of acute pyelonephritis was significantly reduced af ter anti-reflux surgery (P < 0.0001) as well as after diagnosis of vesico-u reteral reflux in the group given conservative treatment (P < 0.001). The f requency of lower-urinary-tract infections was not altered in either group. Surgery had no effect on significant albuminuria (Albustix(R) greater than or equal to2+) or on progressive renal functional deterioration. Forty-thr ee patients reported recurrent loin pain at the time of diagnosis or anti-r eflux surgery. Only one of the 12 patients in the conservative group, compa red with 29 of the 31 patients in the anti-reflux surgery group, obtained r elief from loin pain during the follow-up. Nine patients in the anti-reflux surgery group reported restitution of reduced general well-being after sur gery. These patients had experienced weariness and/or headache before surge ry. Vesico-ureteral reflux was eliminated more frequently (P < 0.01) in the patients operated on by the Politano-Leadbetter procedure (94%) than in th ose operated on by the Hutch procedure (68%). Conclusions. Loin pain is common in adults with vesico-ureteral reflux and is effectively eliminated by anti-reflux surgery. Anti-reflux surgery shoul d be considered in adults with vesico-ureteral reflux and very frequent acu te pyelonephritic attacks only if conservative treatment has failed to alle viate these symptoms. Anti-reflux surgery is not indicated with the aim of arresting renal functional deterioration.