Urinary tract infection (UTI) is responsible for major morbidity and mortality in spinal cord injury (SCI) patients. Several factors appear to be responsible for an increased risk of infection in the neurogenic bladder. Incomplete voiding, elevated intravesical pressure and catheter use contribute to an increased risk of symptomatic urinary tract infection. Frequent exposure to antibiotics increases the risk of infection by resistant organisms. UTIs interfere with rehabilitation, and may lead to secondary urologic complications. The classic symptoms of UTI are unreliable indicators in SCI patients with neurogenic bladder. Lack of pyuria reasonably predicts the absence of UTI in SCI patients. Asymptomatic bacteriuria need not be treated with antibiotics. Symptomatic UTI warrants therapy in all patients.