This chapter deals with Vesicoureteral Reflux (VUR) in neurogenic bladder (NB), which is a specific type of reflux that compared to primary VUR is less likely to resolve spontaneously, has a unique underlying pathophysiological mechanism and whose management is still controversial. VUR can be detected in up to a third of children with NB. When VUR is detected at first video urodynamic (VUD), resolves in up to 30–50% of children within 2–3 years after commencing clean intermittent catheterization and anticholinergic medication. Endoscopic Treatment or Total Endoscopic Treatment should be reserved to children with NB who fail conservative management and demonstrate a smooth bladder wall, good compliance and a bladder capacity >75% of the Expected Bladder Capacity on VUD. Bladder augmentation should be recommended for children with VUR in a poorly compliant trabeculated bladder. High pressure VUR is likely to resolve in 50–97% of these patients with an isolated bladder augmentation while low pressure VUR, detected in the early filling phase of the VUD, in trabeculated bladders has a low-resolution rate and should be dealt with ureteric reimplantation associated to bladder augmentation. It is of greatest importance that the treatment of VUR in children with NB is discussed at multidisciplinary meeting and individualized according to the patients’ symptoms, patients/parents’ compliance to treatment, comorbidity, renal investigations (US, DMSA), renal function (estimated GFR) and most importantly video urodynamics.