In a retrospective study, the pre-operative urodynamic findings of 41 myelodysplastic patients who had undergone enterocystoplasty for intractable incontinence or deteriorating upper urinary-tracts were compared with findings from similar studies. An objective score combining five urodynamic parameters, the Hostility Score, was calculated before and after surgery to assess its clinical applicability in guiding and monitoring patient management. A score of greater than or equal to 5 should be avoided, if possible, as deleterious upper urinary-tract changes can occur even while on conservative management. In this series the mean pre-operative Hostility Score was 5.6, with 26 patients having a mean score of greater than or equal to 5. After surgery the mean score was reduced to 2.8, with no patient having a score of greater than 4. We conclude that the Hostility Score is a reliable tool for the management and follow-up of patients who have neurogenic bladder disease as a result of myelodysplasia.