OBJECTIVE: The surgical management of sphincteric urinary incontinence in children is a challenging problem for the urologists. We present our early prospective data of the rectus fascial sling procedure. PATIENTS AND METHODS: Since May 1999, 33 patients (30 male and 3 female) aged between 4 and 22 with 5 adolescent male patients (19-22 years old) underwent rectus Fascial sling cystourethropexy as a tool for achieving urinary continence. The underlying cause of incontinence was myelodysplasia in 26, traumatic spinal cord injury in 5 and following surgery and chemotherapy for sacrococcegeal tumors in 2. Patient selection for the sling procedure was based on videourodynamic (open bladder neck and LPPv < 100 cm H2O) and clinical (evident SUI) criteria. All these patients had failed regimens of pharmacological therapy and intermittent catheterization. 29 patients underwent Augmentation cystoplasty concomitant to the sling procedure, while the other 4 patients already had capacious compliant bladders and only a sling procedure was done. Additional concomitant procedures included antireflux surgery in 3 patients, external urethral meatotomy in 3 patients. The follow up period ranged from 6 to 34 months (average 20 months). All data were based upon 24 hours voiding diaries, clinical and Videourodynamic evaluation. RESULTS: 26 patients ( 78.8 % ) were continent on CIC every 4-6 hours , 4 patients (12.1 % ) were partially continent ( can stay dry for about 3 hours ) and require more frequent CIC, 3 patients ( 9.1 % ) didn’t benefit from the sling procedure. 4 out of these 7 patients showed marked improvement by undergoing periurethral injection of bulking agent (Silicon). All patients are catheterizing per urethra. The complications encountered included one female with UVF that required abdominal repair, 3 cases of urethral false passage causing difficult catheterization and managed by an indwelling catheter for 10-14 days, 2 cases of acute epididymo-orchitis. COCLUSION: the rectus fascial sling procedure is a simple, effective, low cost procedure that can be easily done concomitant to other surgeries (Augmentation cystoplasty and/or antireflux surgery). Patients when properly selected do benefit from the procedure. Long term follow up data are required to confirm these early results.