Vesicoureteral reflux is the most common urinary tract abnormality among children, estimated to be present in approximately 1-2% of them. There are various possibilities of evolution, from asymptomatic forms with spontaneous remission to recurrent acute pyelonephritis, reflux nephropathy, or even end-stage chronic kidney disease. Therefore, the early diagnosis, with a correct staging, is essential, allowing the optimal therapeutic approach. The most common clinical situations requiring imaging investigation of vesicoureteral reflux are repeated urinary tract infections, fetal hydronephrosis, familial vesicoureteral reflux, bladder bowel dysfunction, and complex uropathies. The therapeutic management is decided according to the reflux severity, the clinical manifestations, and the patient’s age. The main objectives of the treatment are to prevent urinary tract infections, the development of renal scars, and the progression toward chronic kidney disease. The therapeutic approach may involve active follow-up, continuous antibiotic prophylaxis, or surgical intervention. Active follow-up applies to asymptomatic patients with an increased likelihood of spontaneous remission. Antibiotic prophylaxis is the most frequently adopted approach, used in patients with previous urinary tract infections and high-grade reflux. The surgical approach is reserved for cases with a low probability of spontaneous remission and for those with unfavorable evolution under conservative treatment. The surgical methods used are represented by endoscopic injection of an antireflux substance, classical or robotically assisted surgery, with similar success rates. Currently, there is no consensus regarding the therapeutic approach to these patients, the pediatrician being the one who must evaluate each case and propose and individualized therapeutic management adapted to the needs of each patient.