A total of 58 children with myelodysplasia underwent radiographic and cystometric evaluation and were followed periodically for an average of 58 months. Of this group 30 (52 per cent) demonstrated vesicoureteral reflux, including 16 with low grade and 14 with high grade reflux. In 6 children low grade vesicoureteral reflux resolved with prophylactic antibacterials only, while decompressive treatment was required in 6, antireflux surgery was required in 2 and 2 were lost to followup. Despite adequate decompressive treatment 12 of the 14 children with high grade vesicoureteral reflux required an antireflux operation and 2 were lost to followup. Among those who underwent an operation there has been no recurrent reflux but 3 children have shown evidence of upper urinary tract deterioration. We describe our current approach to the treatment of vesicoureteral reflux in children with neurogenic bladder dysfunction and suggest a management protocol based on urodynamic findings.