Background: Augmentation cystoplasty (AC) is a surgical procedure used to manage pediatric neurogenic bladder (NB) when conservative treatments fail. While AC improves bladder function and continence, it carries significant long-term risks. This systematic review and meta-analysis evaluate the functional benefits and complications of AC in pediatric NB patients. Methods: A comprehensive search of PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library was conducted from inception until February 14, 2025. Eligible studies included pediatric patients (≤18 years) with NB who underwent AC. Primary outcomes were continence improvement and bladder capacity increase, while secondary outcomes included complications such as bladder stones, perforation, and reoperation rates. A one-group meta-analysis was performed using logit transformation for categorical outcomes and weighted mean differences (WMD) for continuous outcomes. Heterogeneity was assessed using I2 statistics. Results: Nine retrospective cohort studies comprising 696 pediatric patients were included. The pooled continence improvement rate was 78.1 % (95 % CI: 62–89 %), and bladder capacity increased by 82.1 % (95 % CI: 64.3–99.9 %). The incidence of bladder stones was 19.3 %, bladder perforation was 6.0 %, and reoperation occurred in 24 % of cases. Significant heterogeneity was observed for reoperation rates (I2 = 97 %). Conclusion: AC effectively improves continence and bladder capacity in pediatric NB patients, but it carries a substantial risk of complications. The high reoperation and complication rates underscore the need for careful patient selection, standardized surgical techniques, and structured follow-up. © 2025 The Authors