Vesicoureteral reflux (VUR) is commonly seen in patients with posterior urethral valves (PUV). The high intravesical pressures and bladder dysfunction associated with PUV predispose these patients to secondary VUR. Early detection through investigations like voiding cystourethrography, radionuclide cystography, and renal cortical scintigraphy is crucial for timely intervention and prevention of complications such as recurrent urinary tract infections, pyelonephritis, renal scarring, and deterioration of renal function. Management strategies involve a multidisciplinary approach, including antibiotic prophylaxis, urotherapy, clean intermittent catheterization, and surgical options like endoscopic injection or ureteral reimplantation. Bladder dysfunction plays a pivotal role in influencing clinical outcomes and treatment success. Urodynamic studies, combined with fluoroscopy, provide valuable insights into bladder function and guide tailored treatment decisions. Further research is needed to identify predictive factors, evaluate long-term outcomes, and explore innovative diagnostic and therapeutic approaches for optimizing the management of VUR in PUV patients.