Recent publications have focused on the incidence of vesico-ureteral reflux in children affected by other urinary tract malformations such as multicystic kidney and renal agenesis. Urodynamic evaluation may play an important role in understanding the pathophysiology of reflux. Many efforts have been made to try to optimize the results of both endoscopic and surgical treatment, minimizing, at the same time, patients' discomfort and costs. In this respect, endoscopic treatment and extravesical anti-reflux procedures seem to offer some minor advantages over the traditional intravesical procedures.