my daughter is suffering from primary VUR Gr3/Gr2 left&right withnormal DMSA report,without hydronephrosis&renal dysplasia.she had one febrile UTI at the age of three in2007.she was on ABP (uritop1/3 dose)recently she had one breakthrough UTI managed medically.Now the doc is telling it is persisting one you have to undergo a surgery called ureteral re-implantationand mentioning that she may not have any problem now but in future during her pregnancyin the form of HTN&ESRD.but my search in medical databases which includes meta analysis,sys reviews&RCT s are showing no significant difference between medical&surgical management.moreover prenancy related problems are only due to congenital renal dysplasia not due to VUR.MY queries are; 1.is surgical management necessary?is there any evidence for it s superiority? 2.can we wait till puberty for self correction? --3.can medical management be an option? 4.is there any study evidence the primary VUR led to pregnancy problems? 5.what are the latest articles in this regard?