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Abstract
Careful selection of patients for operation for vesicoureteral reflux prevents an inexorable trend toward severely scarred kidneys and uremia. Operation may be necessary in reflux causing considerable dilatation and ballooning of ureters, in complete duplication of a double kidney, in ureters with ectopic openings, and after injury to the ureteral orifice, ureteral meatotomy, or unroofing of ureteroceles. Medical treatment alone is preferable for reflux that is mild, intermittent or difficult to demonstrate or disappears with antimicrobial therapy.