OBJECTIVES To assess, in a prospective study, whether botulinum toxin A (BTXA) injected into the detrusor muscle is safe and well tolerated, produces significant changes in urodynamic variables, if the effect is durable, as measured by the Bristol Female Lower Urinary Tract Symptom Questionnaire (BFLUTS), and to assess changes in quality of life, as measured by the Kings Health Questionnaire (KHQ), when it is used to manage idiopathic detrusor overactivity. PATIENTS AND METHODS This was a single‐centre, prospective unrandomized study of 15 women to assess the efficacy of a single dose of 300 units of BTXA injected intravesically into the detrusor muscle, under cystoscopic control. Patient evaluation included a full history and examination, frequency/volume charts, BFLUTS and KHQ scores, and a conventional urodynamic study at baseline and at 6 weeks after treatment. Symptomatic improvement was assessed at 6 weeks and every 4 weeks thereafter until baseline values were reached. RESULTS All 15 patients completed the study; 14 noted an improvement in urgency and frequency immediately after treatment. There were no major adverse effects reported to date. The volume at first desire to void increased in 13 patients (P < 0.006), the maximum cystometric capacity increased in 10 (P < 0.011) and six of the 15 had no evidence of detrusor overactivity; in the remaining eight the volume at first overactive contraction increased in six (P < 0.0023) and the volume at first overactivity incontinence increased in 11 (P < 0.005). The median modified projected isovolumetric pressure decreased significantly (P = 0.01), from 69 to 45. The improvement in frequency appeared to last up to 24 weeks, and that in urinary incontinence up to 20 weeks. The overall improvement in quality of life was maintained up to 24 weeks. CONCLUSION BTXA appears to be a safe treatment with good clinical efficacy in refractory idiopathic detrusor overactivity; the effects seem to last 20–24 weeks.

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Interest in female urinary retention has increased recently because of improved understanding in the pathophysiology as well as the availability of specialised treatments such as sacral neuromodulation. There is little in the literature regarding the incidence and aetiology of urinary retention in females. We therefore undertook a review of all female retention patients presenting to our urology unit over an 11 year period. Methods: 300 females presented with retention in 11 years January 1996 to January 2007 (7% of the male incidence). 81 presented more than once. Median age was 67. Aetiology included urethral stenosis (n = 51), urinary tract infection (n = 33), constipation (n = 23), neurological causes (n = 14), gynaecological causes (n = 16), non urological post-operative patients (n = 21), medications (n = 7) and clot retention secondary to bladder cancer (n = 12). Results: Ultrasound (n = 240) was carried out in the majority, cystoscopy (n = 140), and urodynamics in a minority (n = 38). Urethral pressure profilometry (n = 38) revealed significantly higher closure pressures as compared to a control group -median 90 vs. 57 mmH20 (p = 0.02). 245 had successful trials without catheter. Prior to this, treatments included cystoscopy and urethral dilatation (n = 73), laxatives (n = 25) or antibiotics (n = 29). Initially 54 patients were taught intermittent self-catheterisation; 38 patients were unable to perform this, and left with a long-term catheter. Conclusions: The number of female retentions encountered in our practice is fairly high, with very few of these fitting the criteria for sacral nerve stimulation. In a third no aetiology was found. Approximately half of those who successfully voided did so with no treatment.

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