Neuropathic bladders in children are mostly related to myelodysplasia. In the EAU/ESPU guidelines, medical and surgical management are outlined. A proactive approach is advocated by starting intermittent catheterisation (IC) as soon as possible. In those with detrusor overactivity confirmed in early urodynamic studies, anticholinergic medication should be started. With this management, up to 80% of the children can achieve adulthood without further more invasive treatment. In those, who develop a low-compliant bladder or overactive detrusor despite maximal conservative management, surgical interventions such as botulinum toxin-A injections into the detrusor muscle, bladder augmentation, and even urinary diversion should be considered. In patients, who have difficulties in performing IC due to anatomical or other reasons, creation of a continent catheterisable channel, and in those with an insufficient bladder neck a bladder outlet procedure or bladder neck closure should be offered. Besides preservation of the urinary tract function, stool management is an important factor to improve quality of life. Urinary tract infections should only be treated in symptomatic patients. Besides a close follow-up to detect complications and metabolic consequences early, a good transition to adulthood is extremely important.