OBJECTIVES: Healthcare guidelines are an important vehicle in establishing up-to-date evidence based medicine (EBM) in clinical practice. Due to varying development processes, clinical guidelines created by different institutions can often contain contrasting recommendations. This can have implications for optimal and standardised patient care across management settings. A substantial evidence base underpins treatments use in neurogenic bladder (NGB) but is dominated by observational studies and clinical studies with weak methodological design. This increases the likelihood that recommendations are based on subjective expert opinion. METHODS: The similarities and differences of treatment recommendations made in the National Institute for Health and Care Excellence (NICE), The European Association of Urology (EAU) and the International Consultation on Continence (ICI) guidelines for NGB were assessed. RESULTS: The guidelines generally agree on their approach to conservative management, including for behavioural therapies and catheterisation techniques. There was discrepancy on the value of alpha-blockers and on the use of Botulinum toxin A (BTX-A) in certain neurological conditions. The highest degree of divergence was seen in recommendations for surgical treatments, where the EAU made gender-specific recommendations, and gave continent urinary diversion higher preference than given in the NICE and ICI guidelines. CONCLUSIONS: NICE, the EAU and ICI place differing emphasis on costs and expert opinion, which translated in notably different recommendations. It is evident that increased research efforts, possibly in the form of prospective registries, pragmatic trials and resource utilisation are necessary to improve the underlying evidence base for NGB, and subsequently the strength and concordance of recommendations across guidelines.