Objective: Prospective analytical study in children below 12 years of age with complicated and recurrent UTI requiring hospitalisation between April 2018 to December 2020. Abnormal USG findings like pelvicalyceal/ureteral dilatation, hypoechoic renal echotexture, edematous kidneys and focal nephronia were correlated statistically with gold standard MCUG. Methods: Prevalence of VUR is 35% in 685 subjects who underwent MCUG. 597 subjects with both MCUG and USG at our centre were analysed for correlation among both. Among children below 1 year, USG has sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)  of  61.5%, 44.1%, 33.3%, 61.7% respectively ; among 1-5 years the sensitivity, specificity, PPV, NPV of  56.6%, 40%, 41.8%, 54.7% respectively and > 5 years sensitivity , specificity ,PPV,NPV  80%, 41.5%, 40%, 80.9% respectively. All age groups combined Sensitivity is 60.9%, low Specificity of 42.4%, significantly lower Positive predictive and Negative predictive values of 37.3% and 65.9% respectively with meagre diagnostic accuracy of 49.1%. Assessment of strength of agreement between both modalities was AUC = 0.51 suggesting failed agreement and Spearman’s correlation revealed  a rho value of 0.03 inferring a very weak correlation Results: Ultrasonography has diminished statistical significance as a decision making tool for ordering MCUG in children with UTI. The lack of correlation is evident among all age groups hence the suggestion of current guidelines on conducting MCUG based on USG needs revaluation. Owing to higher prevalence of VUR ( 1 in 3 children with UTI) MCU can be considered irrespective of normal / abnormal USG findings Conclusions: Objective: Assess the decision making ability of Ultrasonography (USG) to conduct Micturating Cystourethrography (MCUG) by evaluating sensitivity, specificity and predictive values in children with complicated urinary tract infection(UTI) and determine the prevalence of vesicoureteral reflux (VUR) Methods: Prospective analytical study in children below 12 years of age with complicated and recurrent UTI requiring hospitalisation between April 2018 to December 2020. Abnormal USG findings like pelvicalyceal/ureteral dilatation, hypoechoic renal echotexture, edematous kidneys and focal nephronia were correlated statistically with gold standard MCUG. Results: Prevalence of VUR is 35% in 685 subjects who underwent MCUG. 597 subjects with both MCUG and USG at our centre were analysed for correlation among both. Among children below 1 year, USG has sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)  of  61.5%, 44.1%, 33.3%, 61.7% respectively ; among 1-5 years the sensitivity, specificity, PPV, NPV of  56.6%, 40%, 41.8%, 54.7% respectively and > 5 years sensitivity , specificity ,PPV,NPV  80%, 41.5%, 40%, 80.9% respectively. All age groups combined Sensitivity is 60.9%, low Specificity of 42.4%, significantly lower Positive predictive and Negative predictive values of 37.3% and 65.9% respectively with meagre diagnostic accuracy of 49.1%. Assessment of strength of agreement between both modalities was AUC = 0.51 suggesting failed agreement and Spearman’s correlation revealed  a rho value of 0.03 inferring a very weak correlation Conclusions: Ultrasonography has diminished statistical significance as a decision making tool for ordering MCUG in children with UTI. The lack of correlation is evident among all age groups hence the suggestion of current guidelines on conducting MCUG based on USG needs revaluation. Owing to higher prevalence of VUR ( 1 in 3 children with UTI) MCU can be considered irrespective of normal / abnormal USG findings