Altered bladder physiology as a result of neuromuscular disease may exert a profound influence on upper urinary tract function. Upper urinary tract abnormalities may occur in these patients in the absence of symptomatology and a systematic program of long-term surveillance is required. Monitoring the upper urinary tract to detect abnormalities that would require an alteration in bladder management is likely one of the key factors that has resulted in the decreased morbidity and mortality in neurogenic bladder dysfunction. Excretory urography, comprehensive renal scintillation procedures, and renal ultrasound examinations all have played a role in monitoring upper urinary tract dysfunction. Cystourethrography has been utilized to detect vesicoureteral reflux. Comprehensive renal scintillation procedures have some distinct advantages over excretory urography, including lack of adverse reactions, lack of need for bowel preparation and dehydration, and lower radiation exposure. These factors have improved patient compliance in returning for follow-up examinations. The sensitivity of the comprehensive renal scintillation procedure has allowed it to replace the excretory urogram, the cystourethrogram, and serum creatinine as monitors of upper urinary tract function at our institution. Renal ultrasound examinations have been utilized recently by some investigators and results compare favorably with excretory urography. We are currently evaluating the renal ultrasound examination against the comprehensive renal scintillation procedure and excretory urography to determine its future role for upper urinary tract screening in neurogenic bladder dysfunction.