Early diagnosis and the use of new pediatric endoscopic equipment have significantly improved the survival of infant boys with posterior urethral valves. The sequelae of urethral obstruction in these patients includes abnormalities in the urethra, bladder, ureters, and kidneys. The question remains of how best to treat all valve patients to maximize function of the entire urinary tract. Our experience with early valve ablation (EVA) suggests that the damaged bladder and upper tracts have a potential to heal if the obstruction is removed and the bladder is allowed to fill and empty cyclically in the first few months of life. One year after EVA, even patients with severe obstructive changes show return of normal bladder capacity and compliance, and resolution or improvement in reflux. Unfortunately, the renal insufficiency associated with valves often is secondary to primary renal dysplasia, with many patients progressing to renal failure and transplantation. Upper tract diversion has failed to improve long-term outcome in patients with renal dysplasia; furthermore, it jeopardizes the potential for bladder healing and normal bladder function. Therefore, even for patients with renal insufficiency, early primary ablation should be used as the definitive treatment for posterior urethral valves.