Background: Renal injury is a severe consequence of vesicoureteral reflux (VUR). Although voiding cystoureterography (VCUG) is considered the gold standard procedure for diagnosis, it is to little concern invasive technique and has a significant radiation risk. It is recommended to use ultrasonography as a screening technique to determine whether VUR is present. The aim of this study was to estimate the appropriate role and indication for ultrasonography in the context of VUR disease and to compare the results with the gold standard, VCUG. Methods and patients: This cross-sectional study included 100 recurrent urinary tract infection (UTI) children who were referred to the radiology department, Benha University Hospital, and the pediatric hospital between January 2023 and September 2023. Every patient had a complete medical history and radiographic, as well as a radiological assessment that included an ultrasound and VCUG. Results: 78% of cases were identified by ultrasound, whereas 32% of patients with VUR in ascending VCUG were not identified by ultrasonography. Compared to low grade VUR, the percentage of high grade VUR patients with increased renal size, increased echogenicity, dilated ureters, thicker ureteral wall, prominent renal pelvis, and thicker pelvic wall was much higher. After evaluating ultrasound's diagnostic potential using receiver operating characteristic (ROC) curve, it was discovered that US had 100% specificity and 78.5% sensitivity for identifying VUR instances. In conclusion, ultrasound offer better evaluation renal size parenchymal thickness and scaring and degree of hydronephrosis and follow up with treatment.