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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "According to recommendations from the European Association of Urology and the American Urological Association, we decided to operate on children with VUR grade III or more, with renal dysfunction (DMSA < 40%) or renal scarring demonstrated on isotope renography, and children developing recurrent pyelonephritis despite optimal medical treatment."

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "Catheter occlusions secondary to fibrin or blood clot can be managed with tissue plasminogen activator (TPA). Two milligrams of TPA reconstituted in 40 cc of normal saline, and instilled in the catheter for 1 h, resulted in restoration of patency in 57 % of catheters [26]. Another technique described is the use of an endoscopic retrograde cholangiopancreatography cytology brush to manipulate a malfunctioning PD catheter, with subsequent flushing of the catheter with heparinized saline through the injection port to remove any clot or fibrin." Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "If nonoperative treatments such as flushing, thrombolytics, and fluoroscopic manipulation are unsuccessful, then laparoscopy with catheter repositioning may be necessary"