VUR is the abnormal flow of urine from the bladder into the upper urinary tract.[1] It is commonly associated with PUV as seen in this case.[5,8] In the majority of cases, it occurs as a result of a primary maturation abnormality of the vesicoureteral junction or a short distal ureteric submucosal tunnel in the bladder that alters the function of the valve mechanism.[6,10]VUR is present in about 50% of patients with PUVs[2,7] and is more often unilateral than bilateral[2] as reported in this case.Unilateral reflux, may occur in up to 35% of boys with PUV and has been linked with protected renal function.[3,4] This might be the reason for the preservation of renal function in this patient. This patient had severe left unilateral VUR, characterized by gross dilatation and tortuosity of the right ureter; gross dilatation of the renal pelvis and calyces regarded as a grade V based on the International Reflux Committee Study.