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Schurch was first to report the effect of injecting BTX-A into the detrusor muscle of patients with NDO.[7] this was followed by numerous studies confirming the benefit of BTXA on NDO.[8,9,10,11,12,13,14,15,16,17,18,19,20] The aim of the study is to report the effectiveness and safety of OnabotulinumtoxinA (Botox, Allergan, Inc., Irvine, CA, USA) intradetrusor injections in SCI patients with refractory NDO. MATERIALS AND METHODS After receiving approval from the local Ethics Committee we reviewed the chart of 103 patients with NB secondary to SCI at the rehab center who received OnabotulinumtoxinA in our Neurology [http://en.wikipedia.org/wiki/Mycoplasma MycoClean Mycoplasma Removal Kit] Department for treatment of lower urinary tract symptoms between January 2007 and December 2010. Patients were refractory to at least 2 antimuscarinic agents, each ingested for >2 month; All patients had a clinical examination, urinalysis at 3,6,12 months and a urodynamics study at baseline and 3 months after treatment as well as a visual analogue scale (VAS; range scale: 0�C10) and a bladder diary checked [http://www.selleckchem.com/products/MG132.html MG132] for 3 days. Clean intermittent catheterization was also performed by all patients before the injection, but they suffered incontinence between catheterizations. All eligible patients provided written informed consent before entering the treatment program. Urodynamic assessments before treatment and 3 months after injections were performed according to the ��Good Urodynamic Practice�� recommended by the International Continence Society.[21] Under sedation, [http://www.selleckchem.com/products/Rapamycin.html Akt inhibitor] we used 300 IU of OnabotulinumtoxinA, detrusor muscle injections were performed in 30 sites under cystoscopic guidance, trigone and bladder neck sparing. Botox was diluted in 30 ml 0.9% NaCl and 1 ml of solution were injected for each site. Patients were asked to gradually reduce antimuscarinic medication from the 1st week until the complete suspension of the drugs. Outcome measures included frequency of urge urinary incontinence collected by bladder diaries; changes in urodynamic parameters such as maximum cystometric bladder capacity (MCBC), reflex volume (RV), maximum detrusor pressure; side-effects; antimuscarinic drug consumption and QOL measured with VAS. Statistical analysis Statistical analysis was performed with the ANOVA test to compare the change in urodynamic parameters. The t-test was also used to compare the changes in the VAS score and the bladder diary after injection. For descriptive purposes, mean and standard deviation (SD) were calculated. A probability value of P