Aim: Complete successful management of bladder and bowel incontinence in spina bifida (SB) patients is a challenging undertaking requiring perseverance and a tailored approach. Success needs meticulous pre and post-operative care and planning. Over the past 10 years, we have evolved a much greater understanding in the management of these cases and now achieve gratifying results. We have incorporated several new thoughts and techniques - such as the concept of 'medical augmentation', simple bedside urodynamics, futility of invasive bladder neck repairs, the MACE operation etc. This presentation analyses the outcome of past 10 consecutive cases (2004-2007), and highlights our current protocols and practices in this field. Materials and Methods: During 2004-2007, we have seen a total of 56 new cases, who had Bladder and Bowel incontinence (1 day to 18 years). Incontinence management of 10 cases has now been completed. These patients were evaluated only by Simple Bedside Urodynamic Evaluation. Pre-op, patients were put on CIC (except one patient). Immediate Pre-op preparation consisted of Total Bowel irrigation and Intravenous antibiotics. 6 patients underwent Augmentations - Colocystoplasty 5, Ureterocystoplasty 1, Bladder Neck procedures in 4 (Young Dee Leadbetter -1, Endoscopic inj. - 2, neck suspension 1), Mitrofanoff (2), Ureteric Reimplants 3, MACE procedures 2. Results: Earlier the patients had dry intervals (for urine) ranging from 10 mins to 40 mins. All patients were soiling underclothes with feces everyday. 7 of the ten patients were attending school but had had significant difficulties for continuation due to their incontinence. All patients (except one) were put on upfront CIC, Anticholinergics and simple enemas. Of the 10 cases, 3 girls were adequately continent for urine (>4 hrs dry interval) with CIC and anticholinergics alone. The other 7 cases required further surgical management for achieving satisfactory bladder and bowel continence. Conclusions Complete and successful management of Incontinence in SB requires careful and meticulous planning and proper application of selected surgical techniques for individual cases. After complete management of their incontinence these children are now much happier and active in school, and with their peers. It has also been possible for them to perform the CIC and enemas themselves thus leading more independent lives. [ABSTRACT FROM AUTHOR]