Extravesical antireflux operations following Lich-Grégoir technique, intravesical Politano-Leadbetter technique as well as intra- and extravesical ureteroneocystostomies have been done on 433 ureters from 1977 to 1982 treating children with vesico-ureteral reflux and different concomitant malformations. Compared with results obtained in this institute from 1968 to 1973 antireflux operations were found to reliably form an antireflux mechanism whatever technique is used. Results of the "International Reflux Study Group" will be available in the near future. Looking at the variety of conditions grouped together under the diagnosis of vesico-uretero-renal reflux risk factors can be identified directing treatment strategy and surgical intervention. In children with concomitant vesical pathology like Hutch's diverticulum, ureterocele formation and refluxing double ureter surgery is primarily used. Children after correction of infravesical obstruction should be regarded as a high risk group and be submitted to antireflux surgery if reflux does not resolve spontaneously shortly after relief of infravesical obstruction. It is in children with sphincter-detrusor-dyssynergia causing functional infravesical obstruction where antireflux surgery is recommended if micturition without residual urine is not restored quickly. Finally in cases of poor patient compliance antibiotic prophylaxis should be omitted and substituted by antireflux surgery.