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ABSTRACT: Purpose:: Siblings of patients with vesicoureteral reflux (VUR) are at greater risk of having reflux than the general population, and the role of screening in this group is widely accepted. While voiding cystourethrogram (VCUG) is the gold standard for diagnosis of VUR, ultrasound (US) is often used for screening select patients. We examine the outcomes of a conventional US screening program in older asymptomatic siblings. Materials and Methods:: Between 1984 and 2003 asymptomatic siblings older than 5 years as well as children whose parents refused VCUG were screened with conventional US and urine studies. If US showed a discrepancy in renal size, renal scarring or hydronephrosis, or a change in the size of the renal pelvis during the study, then VCUG was performed. Additionally, any child with a normal US who subsequently had symptoms of urinary tract infection was then referred for VCUG. Chart review was performed and 117 siblings were identified who met these criteria (age range 2 months to 15 years). An attempt was made to contact all 117 siblings to obtain long-term followup data. Results:: Of the 117 siblings 11 (9.4%) were referred for VCUG secondary to abnormal US findings (9) and development of urinary tract infection (2). VCUG was negative in the 2 symptomatic children, while 5 of the 9 (55.6%) with abnormal US were found to have VUR. Telephone contact was established with 85 of the 117 (72.6%) siblings or their parents (average followup 8.3 years, range 2 months to 19 years). All 85 siblings with available followup information had normal US, and none had had symptoms or complications of VUR since screening. Conclusions:: Given the lower incidence and seemingly innocuous nature of VUR in older asymptomatic siblings of known patients with reflux, observation alone in this group is an acceptable form of management. If either parental or physician anxiety exists in this approach, then conventional US offers a reliable alternative to invasive VCUG screening in this population. [Copyright &y& Elsevier]