الفهرس 
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Abstract
Children who experience febrile urinary tract infections(UTIs) without explanation on standard radiographic studies instead that their clinical course suggests vesicoureteral reflux to be the cause of the infectionsremain a diagnostic problem, also Misdiagnosis may still lead to significant renal morbidity, and frustrate the physician and family
Management of infants with VUR should take into consideration the likelihood of spontaneous resolution, the likelihood of recurrence of UTI and the risk of developing renal parenchymal abnormalities
Criteria used to determine the need for intervention:
Persistent grade III-V VUR in child more than 1 year,
Development of a breakthrough UTI (BT-UTI) manifested by (fever, dysuria, frequency, failure to thrive or poor feeding) during CAP.
Treatment noncompliance and deterioration of renal function.
Family preference.
Endoscopic treatment involves submucosal injection of a bulking agent into the bladder wall below the ureteral orifice, or within the ureteral tunnel, to provide tissue augmentation.
The basic principle is to provide a solid support under the refluxing ureteral orifice thereby increasing the submucosal length of the ureter and also to create a fixation point for the ureter so as to improve the valve mechanism and stop urine from refluxing into the ureter.
Success of the endoscopic correction of VUR is dependent on the technique with success rate was estimated to reach 79% of ureters with grade 1-2 reflux, 72% with grade 3 reflux and 65% with grade 4 after the first injection; however success rate reached 85% after the second injection and up to 90-95% with the use double HIT technique