Vesicoureteral reflux (VUR) is the greatest and most recent challenge in pediatric nephrology, with explosive and relentless growth of knowledge. Many diagnostic and therapeutic indications must be revised with regards to up-to-date discoveries on the origin and evolution of congenital anomalies of kidneys and urinary tracts (CAKUT), because prompt diagnosis and aggressive intervention often seem to have only marginal influence on remote prognosis. Diagnostic strategies must tend to minimize the number of useless studies, preferring the ones that are less invasive and which expose to the smallest radiologic risk, reminding that the target is prevention of parenchymal damage, and not detecting VUR.