Vesicoureteral reflux in children: to operate or not to operate? What to do when nephrologist and surgeon disagree

Congenital anomalies of the kidney and urinary tract are the primary cause of end-stage kidney disease in children, and vesicoureteral reflux is among their most common manifestations. Deciding which child with reflux truly benefits from surgical correction remains one of the most persistently unresolved questions in pediatric nephrology and urology, and recommendations for a given child continue to differ between the nephrologist and the surgeon involved in their care. This paper summarizes the current risk-based framework for surgical decision-making in reflux, deliberately focusing on the central clinical question of which child benefits from surgery. Related topics, including the natural history of reflux, diagnostic algorithms, bladder and bowel dysfunction, continuous antibiotic prophylaxis, and the technical details of surgical procedures, are referred to where they inform this decision but are not discussed in depth here, as they are covered in separate articles. An individualized, multidisciplinary approach, with preservation of kidney function as the guiding principle, remains the most defensible course.