**5. Refractory cases to medical management**

The objective of neurogenic bladder management secondary to myelomeningocele is focused on three main objectives: 1) Decrease the risk of renal damage 2) Preserve urinary continence and 3) Prevent urinary infection episodes. When these objectives are not reached with medical management, it is necessary to take more drastic decisions, otherwise, further problems regarding renal function may be encountered and quality of life may be affected. Such procedures include:
