OBJECTIVE The prevalence of vesicoureteral reflux (VUR) in hypospadic patients is reportedly higher than in healthy children. We investigated the prevalence and the clinical course of VUR in hypospadic patients. METHODS We carried out intraoperative cystography to detect VUR in 338 patients who underwent hypospadias repair. Age, severity of hypospadias and the presence of VUR were investigated. A dimercaptosuccinic acid renal scan and follow-up voiding cystourethrography (VCUG) were carried out if VUR was detected. RESULTS VUR was detected in 41 patients (12.1%). Of 156 patients who were younger than 1 year-of-age, 34 (21.8%) were found to have VUR. The prevalence of VUR was significantly higher in patients younger than 1year (P<0.001), but was not associated with hypospadias type (P=0.212). The reflux grades were I, II and III in 6, 52 and 1 renal units, respectively. Renal scarring was shown in one of 36 patients. Follow-up VCUG was carried out in 30 patients at a mean of 14.28±3.89months, and reflux resolved in 27 and improved from grade II to grade I in three patients. CONCLUSIONS Although its prevalence is higher in hypospadic children than in healthy children, it is not necessary to screen for VUR in hypospadic patients, because it is likely to be low-grade and to resolve in most cases.