Radiological voiding cystourethrography has long been considered the gold standard for reflux testing in paediatric urology. Additional contrast-based procedures such as voiding urosonography or radionuclide cystography have been established in recent decades. Their main indication is reflux diagnosis after pyelonephritis in early infancy and childhood. The selection of the appropriate method is based on factors such as clinical question, availability, economic aspects, expenditure of human resources and time, and the goal of finding of method that provides as much information as possible while keeping radiation exposure to a minimum. Modern strategies aim for a risk-oriented, individual indication independent of the method of reflux testing.