Pediatric neuropathic bladder dysfunction can cause irreversible renal damage and urinary incontinence. Etiologically, it is usually the consequence of a congenital neural tube defect. The majority of affected children can be successfully managed with the standard medical treatment of clean intermittent catheterization and anticholinergic (typically oxybutynin) medication. A subset of patients experience severe side effects or insufficient suppression of detrusor overactivity on oral oxybutynin. Intravesical instillations offer an effective alternative; this Review considers their indications, administration, safety and efficacy.