Patients (46) with spinal injury with dysfunctional neurogenic bladder were analyzed. Patients (14) on prolonged intermittent catheterization from 12 wk to more than 1 yr did not develop a balanced bladder, 14 patients had indwelling catheters after intermittent catheterization failed elsewhere and 18 patients on external condom drainage presented with difficult voiding and repeated infections. There were 16 quadriplegics (1 incomplete), 31 paraplegics and 9 incomplete cauda equina lesions. Urologic and urodynamic evaluation revealed detrusor-sphincter dyssynergia in 15 patients, vesicoureteral reflux in 10 and areflexic bladders in 11. Five patients over the age of 55 yr showed slight enlargement of the prostate. Some degree of bladder neck fibrosis was suspected in 26. More than 1 urologic pathology was encountered in the same patient. Transurethral sphincterotomy was carried out in 38 patients and only 1 transurethral resection of the prostate (TURP) in an incomplete quadriplegic patient. In 7 patients with no obvious urodynamic abnormality, a balanced bladder was achieved with intermittent catheterization; however, 1 of these patients needed a transurethral sphincterotomy on subsequent admission. A balanced bladder was achieved in all patients except the one with incomplete quadriplegia. Significant improvement in vesicoureteral reflux and relief from autonomic dysreflexic symptoms were recorded in all patients.