Excretory cystourethrography is the standard method for determining the presence and grading of vesicoureteral reflux and provides accurate information on bladder and urethral morphology in addition to grading the reflux. Based on the results of excretory cystourethrography, the International Council for Reflux Research has classified cystoureteral reflux into 5 grades: Grade 1: reflux into a non-dilated ureter. Grade 2: Reflux of urine into the non-dilated pelvis and calyces. Grade 3: Mild to moderate dilatation of the ureter, pelvis, and calyces with mild blunting of the cup. Grade 4: Moderate ureteral tortuosity and dilated pelvic calyces. Grade 5: Severely dilated ureter, pelvis, and calyces with loss of papillae; twisted ureter; and reflux in the renal parenchyma.