Detrusor hyper-reflexia as a factor in spontaneous perforation of augmentation cystoplasty for neuropathic bladder. In a series of 30 children undergoing cystoplasty for neuropathic bladder, 14 had a combination of a competent sphincteric mechanism and detrusor hyper-reflexia. All 3 cases of spontaneous perforation of the augmentation occurred within this latter group and it is postulated that excessive intravesical pressure due to high pressure hyper-reflexia was the causal factor. Strategies to reduce the risk of perforation are discussed. 