The prevalence of vesicoureteral reflux (VUR) among patients with ureteropelvic junction (UPJ) obstruction patients is 8.2%, where one-third of the concomitant VUR are dilated VUR, and two-thirds are cases with non-dilated, low grade VUR with no need for surgical intervention. The etiology for coincidental VUR and UPJ obstruction is a primary ureteral abnormality affecting both ends of the ureter. Children with reflux and true blockage at the ureteropelvic junction have distinct cystographic patterns and the original grading system is not valid when dilatation is also due to obstruction. In the presence of concomitant disease, it is only possible to grade reflux accurately as high or low based on ureteral appearance. For evaluation of the upper urinary tract, technetium-99m (99mTc) mercaptoacetyltriglycine (MAG3) should be used. Once, the decision for UPJ obstruction is made, the child requires surgical correction with pyeloplasty. The choice of treatment can be challenging with refluxing megaureter.