The treatment of neurogenic bladder is a long-standing problem that is still being studied and explored. With the advancement of clinical research and practice, various conventional therapies have been widely used and new therapies have emerged. A comprehensive understanding of the function of the urinary tract is a prerequisite for the development of a treatment plan The nature of neurogenic bladder is a dysfunction due to abnormalities or lesions in the innervation of the lower urinary tract. Currently, the diagnosis of urogenital dysfunction relies only on urodynamic testing, which can clarify the functional status of the lower urinary tract components such as the bladder and urethra and their synergy, and imaging urodynamics, which can also clarify the extent of upper urinary tract destruction such as ureteral reflux. Also intravenous pyelogram, ultrasound, isotope nephrography or urological nuclear water imaging techniques help to understand the morphology and function of the upper urinary tract. Only when the functional status of the urinary tract is clarified can different methods of treatment be selected and implemented in a localized and targeted manner. The treatment plan should be designed with a long-term effect, so that the patient can benefit from the treatment in the long term; it should also pay attention to the integrity and unity of the upper and lower urinary tract function. Indiscriminate administration of treatment should be avoided. The most serious direct consequences of lower urinary tract dysfunction, such as neurogenic bladder, are upper urinary tract destruction, renal failure, and patient death, which have been confirmed in successive investigations of the Tangshan earthquake. Therefore, when designing a treatment plan for neurogenic bladder, both in the immediate and long-term perspective, the following aims and principles of neurogenic bladder treatment must be followed: 1. Protection of the upper urinary tract to ensure survival life, through various measures to create a urodynamically safe state of the bladder (adequate volume, low pressure storage, complete emptying without obstruction; 2. Management of urinary incontinence, restoration of possible urinary control, and improvement of patient’s quality of life. In clinical practice it is often seen that cases with violations of the above principles lead to adverse consequences, such as cases in which a single-minded increase in bladder contractility and emptying of the bladder with neglected management of bladder outlet obstruction leads to upper urinary tract destruction. Therefore, when developing a treatment plan for neurogenic bladder, it is important to consider and emphasize long-term outcomes as well as the systemic and integrity of urinary tract function. Establishing appropriate patient expectations With the current state of technology, it is difficult to completely cure neurogenic bladder, whether due to congenital abnormalities of the nervous system or acquired lesions or injuries, and all that can be done is to take various approaches to preserve renal function, prolong the patient’s life span, and improve the patient’s quality of life as much as possible; the ideal is to restore physiologic voiding. Therefore, we should fully communicate with the patient before starting various treatments to reduce the patient’s expectation of treatment to an appropriate level in order to reduce the occurrence of doctor-patient disputes. Striving to find a balance between life support and quality of life As mentioned earlier, the goal of treatment for neurogenic bladder is first to preserve renal function to maintain life and second to improve the patient’s quality of life. However, when the two conflict, preservation of life should take precedence. For example, in a patient with a high spinal cord injury with upper extremity dysfunction who has severe bilateral ureteral reflux at low pressure and renal insufficiency, this condition is not suitable for bladder enlargement but for sphincterotomy with external urinary collector to control incontinence; although the quality of life is reduced, life is preserved. Therefore, we must strive to find a balance between maintaining life and improving quality of life when administering treatment. There are many unanswered questions in the field of neurogenic bladder treatment, so any meaningful research, new exploratory methods and techniques should be encouraged. Only through continuous exploration can we find the ideal approach and advance the science. For example, intermittent catheterization has been widely proven to be an effective measure for managing certain neurogenic bladders, so we must carry it forward and make it more acceptable and adhered to by patients. Getting the distance between technological advances and clinical reality right Technological advances have indeed brought light to clinical medicine, and the treatment of neurogenic bladder is no exception. Stem cell transplantation, tissue engineering, and other technological advances continue to be applied to the field, but there is often a distance between successful basic research and clinical application. We expect such advances, and we are working towards them at the same time. Some patients, however, have deviations in their thinking due to a lack of proper guidance. For example, we often encounter patients who are waiting for the success of stem cell transplantation, bladder transplantation and other technologies and refuse the clinical conventional methods, which eventually lead to the damage of kidney function. This is a real problem that deserves our deep consideration. The popularization and inculcation of scientific knowledge often encounter such patients in clinical practice, who do not understand our treatment purpose and principles, do not agree with the treatment plan, and do not adhere to the treatment method already chosen. The reason for this is that we do not have enough scientific knowledge in the field of neurogenic bladder, and many correct scientific theories, principles and methods are not widely understood and accepted, which is a real and serious problem in front of our professionals. Where is the future of neurourinary medicine? Where do we need to improve? Where do we need to innovate? These are the questions we need to think about. For example, with regard to intermittent catheterization, we need controlled studies to demonstrate whether this catheter or technique is better than another; of course, innovation is always welcome, and the goal is to make intermittent catheterization simpler and easier to perform. Pharmacological treatment will focus on afferent access, and the results of botulinum toxin treatment are encouraging. Although sacral nerve de-afferent posterior rhizotomy has obvious disadvantages, the combined anterior root stimulation and posterior root conditioning of the fundic nerve is promising, but the problem of dysfunction of the forced urinary muscle? sphincter synergistic dysregulation needs to be overcome. In the field of bladder tissue engineering, we expect that cells from the bladder will be grown on a biological matrix and thus replace the neuropathic bladder. In any case, further efforts should focus on how to avoid destructive surgery, improve symptomatic treatment of compensatory defects, and develop more restorative reconstructive treatments. To date, and in the near future, although neurologic deficits exist, proper initial management of the bladder from the onset of spinal shock, proper bladder rehabilitation, and lifelong neurologic attention remain key to ensuring a nearly normal life expectancy and high quality of life for tetraplegic and paraplegic patients.