The non-operative and surgical treatments of reflux are both very successful, and carry less than a 2% risk of renal damage after the diagnosis has been made and treatment instituted. It is very important, however, to identify the patients with increased bladder storage pressures, because these are particularly at risk of renal damage if infection occurs, or after corrective surgery. The clinical clue to bladder dysfunction is incontinence in the absence of infection. Treatment of the hyperactive or non-compliant bladder, or sphincter dyssynergia, will lower bladder pressures and often reduce the volume of refluxed urine immediately.