Vesicoureteric reflux (VUR) diagnosed following investigation of prenatally-detected urinary tract dilatation (UTD), often remains asymptomatic and yet raises much parental anxiety and medical uncertainty. Previous studies suggest that “prenatal” VUR appears to have a different natural history to that of VUR diagnosed following investigation of recurrent febrile urinary tract infections (UTIs). Reports from Great Ormond Street (1997) and the Society for Fetal Urology registry (1999) highlighted the characteristics of VUR patients diagnosed following investigation of prenatal hydronephrosis, who were noted to be predominantly male with high-grade VUR and established renal uptake defects on DMSA. However, the management strategy tailored to this group of patients is not well-established, mainly due to the fact that studies on VUR management and outcome have included both prenatally-diagnosed and symptomatic patients, confounding the results. There is also a variation in diagnostic protocols following the findings of prenatal UTD, and indications for a micturating cystogram (MCUG) vary between institutions, making the incidence of asymptomatic VUR very variable. Studies focussing specifically on the asymptomatic cohort are few, small, and usually involve patients already on continuous antibiotic prophylaxis (CAP). Hence the true natural history of the condition is not known. A systematic review of 18 articles including 829 asymptomatic infants, mostly males with GIV–V VUR, revealed that 15.4% of infants developed at least one breakthrough UTI despite initiation of CAP from birth. The limited data available showed no conclusive benefit of CAP, primarily due to lack of a strong comparator cohort. The PREDICT trial is the only randomised controlled trial to date, and only included asymptomatic VUR patients, assigned to prophylaxis or no treatment. Febrile UTI’s occurred in 21% of the prophylaxis group vs 35% of the no treatment group, and were more common in females, mostly in the first 6 months. Although the trial showed a small significant benefit of prophylaxis, this came at the expense of non-E Coli and resistant UTI’s in the prophylaxis group. Importantly, there was no difference between the groups in the incidence of new scars at 2-year follow up. The authors concluded that prophylaxis might only be of benefit in girls, for the first year only. This chapter will expand on the evidence behind prenatal ultrasound findings which are indications for a postnatal VCUG; and further investigation and management once VUR is diagnosed in this (initially) asymptomatic patient group.