Treatment of Neurogenic Incontinence with Botulinum Toxin A

To the Editor: Neurogenic urinary incontinence is most often due to detrusor hyperreflexia, and it is usually treated by partially blocking the efferent parasympathetic innervation to the detrusor muscle of the bladder with anticholinergic drugs. These drugs have troublesome side effects, however, and may not restore continence. Botulinum toxin A selectively blocks the release of acetylcholine from nerve endings and accordingly blocks neural transmission. We hypothesized that injections of botulinum toxin A into the detrusor muscle of the bladder might ameliorate detrusor hyperreflexia in patients with neurogenic incontinence by impairing parasympathetic nervous transmission. During the past year, we treated 21 . . .