Smith MC, Strine AC, DeFoor WR, et al. - A retrospective cohort study was done for myelomeningocele (MMC) individuals who underwent an isolated bladder outlet procedure (BOP) between 2004-2017 in order to evaluate long-term outcomes following isolated BOP in a pediatric MMC population, including the requirement for extra surgical intervention in the form of bladder augmentation (BA) or Botulinum toxin injection (BTI). In this cohort of 36 individuals, on time-to-event analysis, the risk of BTI or BA was 53% at 5 years. In the first two years following BOP, the risk of these procedures was greatest. In bladder dynamics, nine of 11 individuals who underwent BTI had an improvement and BA was not continued. These findings imply that in individuals with MMC, BTI gives a less eccentric choice to BA and de novo adverse bladder storage alters following an isolated BOP. Hence, in individuals with MMC, the necessity for BTI or BA following an isolated BOP is important. Moreover, in this population, BTI gives a less invasive option to BA.