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Purpose of Review: Ureteroceles are an infrequently seen and challenging pediatric urological condition that in addition to causing obstruction, may also be associated with vesicoureteral reflux and/or obstruction of the bladder outlet. Past experience with the morbidity associated with ureteroceles presenting with urinary tract infection may have stimulated a particularly aggressive approach as evidenced by more historical reports describing total reconstruction. This article purposes to review the recent literature in support of less aggressive management of ureteroceles in children., Recent Findings: The widespread availability and reported high success rates with endoscopic puncture of ureteroceles, along with the recognition that vesicoureteral reflux associated with ureteroceles can be effectively managed nonoperatively, has shifted the paradigm towards an individualized approach with greater emphasis placed on nonoperative management or less aggressive surgical techniques. Cystic renal dysplasia associated with ureterocele, much like that seen in isolation, is likely to involute thus providing spontaneous 'decompression' of the ureterocele and avoiding the need for surgery when it is present., Summary: Although total reconstruction of renal moieties associated with ureteroceles might be appealing as it can achieve a normal appearing urinary tract with a single procedure performed in infancy, a more individualized approach that relies on less aggressive surgical treatments and nonoperative management over time can achieve the same functional results.

Purpose of Review: Traditional management of vesicoureteral reflux focuses on preventing renal complications associated with ascending urinary tract infection by either providing continuous antibiotic prophylaxis to sterilize the urine and thus prevent recurrent infection, or abolishing reflux via surgical intervention. This review will consider the rationale for antibiotic prophylaxis in light of contemporary data regarding the natural history of vesicoureteral reflux, urinary tract infection and renal scarring, as well as the efficacy of various treatment strategies., Recent Findings: Recent studies have shown that in grades I-IV vesicoureteral reflux, open surgical intervention compared with antibiotic prophylaxis is no better at preventing renal complications. Endoscopic subureteral injection of biomaterials has been proposed as a cost-effective, minimally invasive alternative to surgical or medical intervention; however, given the variety of materials and techniques, the literature has yet to achieve consensus on its efficacy. The first study to compare antibiotic prophylaxis with increased surveillance and prompt treatment of urinary tract infection shows no difference between the two approaches in low-grade (grades I-II) vesicoureteral reflux., Summary: Recent studies have challenged the traditional paradigm of aggressive vesicoureteral reflux management with surgery or antibiotic prophylaxis. In light of these findings, pediatric urologists will need to reexamine treatment modalities for vesicoureteral reflux.