In 43 girls with vesicoureteral reflux and subvesical obstruction (distal urethral stenosis) a urethrotomy was performed as primary treatment. Vesicoureteral reflux was cured by this in 53.5% after a mean control period of 6 months. In these cases the reflux proved to be related to the subvesical obstruction (secondary reflux). The obstruction can cause the decompensation of partially competent vesico-ureteral junctions. The success of urethrotomy depends on the grade of the reflux as well as on the pathology of the ureteral orifice. In persisting cases of reflux a coincidence of subvesical obstruction and primary vesicoureteral reflux has to be discussed, requiring further operative treatment.