Patients with vesicoureteral reflux (VUR) initially come to our attention because of either a prenatal finding of hydronephrosis or a febrile urinary tract infection in the first few years of life. If not already done, initial workup includes a renal ultrasound and possibly a VCUG. Prophylactic antibiotics are often recommended at least until the above-mentioned studies are done. Once the diagnosis of reflux is established, treatment options include surveillance, surveillance with prophylactic antibiotics, and anti-reflux surgery. In general, conservative measures are initially employed and if those fail (e.g., breakthrough febrile urinary tract infections on prophylactic antibiotics), anti-reflux surgery is discussed. At all interactions during the course of patient care, the patient and parents are educated on the nature of reflux and treatment options, so they may make educated decisions. At our institution, robotic anti-reflux surgery is most often approached by an extravesical ureteral reimplant. Although intravesical approaches have also been described, this chapter is limited to the extravesical technique.