The management of vesicoureteral reflux, the most common urological anomaly in pediatric patients, has changed dramatically in the past decade due to the increasing acceptance of endoscopic injection therapy as a minimally invasive and valid form of therapy. Advances in the composition of injectable materials allow easier placement with favorable safety profiles. Specifically, dextranomer/hyaluronic acid has emerged as the favored bulking agent, with quick acceptance and prevalent use soon after its introduction in different countries. However, there are few clear clinical rules to follow, and the choice of management is usually guided by informed parental preferences and the surgeon's treatment philosophy. Important factors that have fostered improvements in endoscopic injections include increased success through advances in injection techniques and better patient selection. Furthermore, clinicians are generally concerned about the possibility of postoperative ureteral obstruction, the durability of the implant volume, and the long-term effects after implantation of dextranomer/hyaluronic acid. In this review, we present the current status of treatment outcomes with endoscopic injection therapy.