patients with neurogenic bladder are the one of the most difficult group for treatment in childhood. They require observation and change of therapeutic tactics with the growth of the child. We assessed the long term results of the treatment in teenagers and young adults for planning of their further management.

19 patients in the age from 14 to 33 (10 females and 9 males) with spina bifida (11), myelomeningocele (4) and 4 with spinal trauma, suffered   in childhood, were examined. Patients with myelomeningocele were observed from infancy. Patients with trauma received rehabilitation under the supervision of urologist from the moment of injury in the age of 2,5-13 years old. Patients with spina bifida came under the supervision of a pediatric urologist at different ages: 4 in infancy, 3 at the age 2-7 years old, others were older. The mean time of follow up was 16 years (6-32). 
Primary upper urinary tract urodynamic characterized by nonobstructive (4) or refluxing (5) megaureter and vesicoureteral reflux (VUR) grade 2-4 in 10 children.

In adulthood renal function, detected by DMSA scanning and glomerular filtration rate (GFR), was damage in most patients. In 6 it was the first stage of chronic kidney disease (CKD) with GFR above 90ml/min, in 7 - second stage of CKD with GFR 60-89ml/min, in 6 – third stage of CKD with GFR 30-59ml\min. Recurrent urinary tract infection presents in 6 patients. Even minimal ureter dilatation was not detected in all adults, so all megaureters in patient with neurogenic bladders were resolved with the growth of the child despite of persistence nonobstructive renal pelvis and calyx dilatation in 5. 
Vesicoureteral reflux (VUR) has remained in 12 of patients in spite of previous surgical correction. For VUR treatment endoscopic correction by bulking agents were done in 10, extravesical ureterocystoanastomosis it 2.
The real functional volume of bladder, when VUR is arise, is the most important index, which allows to choose the tactic of management the patient. In seven cases it occurs on small bladder volume with its underactive contractions, in other 5 patients it’s occurs on the volume of bladder over 250ml with it stable pressure.

So, in these 5 patients with normal functional bladder volume there weren’t kidney damage progression in future.
All 4 patients with myelomeningocele were on clean intermitted catheterization from the beginning. Micturition was either destroyed in all others, but 8 of them can’t pass urine at all and use intermitted catheterization, 5 does it by Crede maneuver having poor desire to urinate and 2 have obstructive micturition with pelvic floor hyperactivity, but biofeedback therapy doesn’t improve it for a long time. Therefore, we suggest using intermitted catheterization in all female patients through natural urethra and making dry vesicostomy in males for emptying the bladder.   
Urodynamic investigation showed underactive bladder contractions in 10 of patients which were treated by repeated injection of botulotoxin type A into detrusor and augmentation cystoplasty in 4 (the operations were done in the age of 12, 17 and 18). Only 5 patients has stable detrusor pressure with normal bladder volume during the some years of follow up and there were no indications for any intervention in them.

patients with neurogenic bladder are in the group of high risk on chronic renal disease development and their low urinary tract function must be closely monitoring during the whole their life. An independent large problem is the vesicoureteral reflux, but it needs further examinations.