Vesicoureteral reflux (VUR) represents one of the most significant risk factors of acute pyelonephritis in children. Nephropathy with renal scarring is still the most concerning issue in VUR. Early detection and monitoring of VUR are the key to management and kidney protection. Evaluation of VUR treatment outcomes should consider not only resolution of VUR over time but also disappearance of urinary tract infections (UTI) and evolution of renal scars.

There are several options for the treatment of VUR including: Surveillance program with or without antibiotic prophylaxis, endoscopic, laparoscopic, and open approach. Surgical correction to eliminate VUR is an important part of the management. Intravesical or Extra vesical technique have been described for the correction of VUR with a high success rate. 

Extra Vesical Ureteric Reimplant is an excellent technique with similar successful rates to the intravesical approach especially when it’s combined with some modifications described in the literature.

Minimally invasive surgery (MIS) for the correction of VUR is being developed as an alternative to open surgery. Endoscopic sub-ureteric injection procedure remains a choice in low grade reflux requiring intervention. Pneumovesicoscopic MIS have been a challenge even for the more experienced surgeons.