A majority of the children with high-grade primary reflux (grades IV and V) will not experience spontaneous resolution, and thus surgical treatment may be offered to lower the risk of renal scarring. Endoscopic techniques often fail to correct high-grade reflux, and thus open or laparoscopic reconstruction of the ureterovesical junction is typically performed. The cross trigonal ureteral implant is a popular technique (see Plate 10-35). Until the reflux is corrected, antibiotic prophylaxis should be provided to maintain sterile urine.