Stress urinary incontinence is a complex problem in patients with a neuropathic bladder, the management of which is often influenced by the underlying neurological cause. Full assessment and appropriate investigation are key to understanding each individual patient’s lower urinary tract dysfunction and their subsequent options for intervention. Investigations must include urodynamic studies and imaging, as well as a full knowledge and understanding of the natural history of the underlying primary neurological abnormality. Management is always aimed at the preservation of renal function and protection of the upper urinary tracts alongside promoting continence and a patient’s quality of life. Conservative management can include different forms of catheterisation (suprapubic, urethral or intermittent self-catheterisation) and other continence devices, as well as lifestyle and behavioural management. Pharmacological options have a limited role, but surgery is often employed either through the use of artificial urinary sphincters or urethral slings. This chapter aims to elucidate the diagnosis, management and treatment options available to this complex group, focusing specifically on patients with proven neuropathic bladder issues. Crucially, it recognises that a multidisciplinary approach focusing on holistic patient management and full patient involvement wherever possible is essential.