The authors report on their more recent experience of the treatment of primary vesico-ureteral reflux and discuss the indications for its either conservative or surgical management. From a surgical point of view, the high reliability of Cohen reimplantation procedure is underlined. Some particular problems (such as reflux in solitary kidney) as well as some technical to-day controversies (such as bilateral procedures) are also discussed. The Authors cannot but agree with the recent widening of the field of indications for surgery, due to the excellent results of the chosen aforesaid procedure.