A plea for standardized grading of vesicoureteral reflux

The voiding cystourethrogram has become the accepted standard for detection and grading of vesicoureteral reflux. Although selection of treatment alternatives and interpretation of treatment results are modified by cystographic findings, no uniform grading system exists. This not only makes comparison of different series awkward, but also hampers efforts to understand the prognostic implications of reflux grading. In reviewing the grading systems available, we feel that adoption of the criteria proposed by the International Reflux Committee (originally proposed by Heikel and Parkkulainen in Europe and Dwoskin and Perlmutter in the USA) is superior in its specificity and should be adopted as an International Reflux Classification.