Fifteen children and young adults with neurogenic bladder undergoing enterocystoplasty were evaluated preoperatively to determine subsequent urinary continence and to establish the need for bladder neck reconstruction. The proximal sphincter mechanism was studied with an erect cystogram under fluoroscopic monitoring and the distal sphincter mechanism was studied with direct electromyography. In 8 patients the distal and proximal sphincters were incompetent, and all underwent a Young-Dees bladder neck reconstruction. In 7 patients 1 or both sphincters were competent and none underwent bladder neck reconstruction during enterocystoplasty. Of the 14 patients followed 13 are continent on intermittent catheterization.