Primary vesico-ureteric reflux must be graded according to severity. Significant reflux up a dilated ureter appears to be an important factor in causing renal damage. There is evidence in favour of the theory that the renal deterioration seen in some cases of reflux can be explained on a congenital basis of site or origin of the ureteral bud and resultant dysplasia of the developing kidney. Surgery should be reserved for selected patients with significant reflux.
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