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Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys. It may present before birth as prenatal ureterohydronephrosis, an abnormal widening of the ureter, or with a urinary tract infection (UTI) or acute pyelonephritis. The International Reflux Grading system classifies VUR into 5 grades depending on the degree of retrograde filling and dilatation of the renal collecting system.1 Vesicoureteral reflux is estimated to occur in 1%–3% of children.1 Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. In children with UTIs, the incidence of VUR is 29% in boys and 14% in girls.2 Although VUR is more common in boys antenatally, in later life there is a definite female preponderance with 85% of patients being female.1,2 Traditionally, if medical management with low-dose antibiotic prophylaxis failed, the only alternative was open surgery.3 In recent years, endoscopic subureteral transurethral injection (STING) has become a first-line therapy for children with VUR because of its high success rates and a very low incidence of complications.1,3–5 Since Matouschek’s initial description of the subureteral injection technique in 19816 and the first clinical series reported by O’Donnell and Puri in 1984,7 it has evolved into a therapeutic alternative to open surgery. Injectable agents, such as Teflon, bovine collagen and Macroplastique, have all been used; however, concerns about efficacy and safety have limited their use.1,3,8 Since the approval of dextranomer/hyaluronic acid copolymer (Deflux), endoscopic management of VUR has become an established alternative treatment in children.1,9 Both dextranomer and hyaluronic acid are biocompatible, which means that they do not cause clinically important reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body.1,9 We present our results of endoscopic treatment using the subureteral Deflux injection (SDIN) for VUR in children at our institution.