More than half of the OAB patients were not satisfied with their first line treatment. Other treatment options should be sought, such as changing the medication or dosage, or possibly combining treatments.

Based on our results, we conclude that urethral bulking therapy is a valuable treatment option in patients with severe SUI who have undergone pelvic radiotherapy for the treatment of gynaecological malignancy.

Study design: This was a multicentre, prospective, randomised study. Objectives: To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO). Setting: Urology departments of two tertiary hospitals in the Czech Republic. Methods: A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment. Results: In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group. Conclusion: Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation. Spinal Cord (2012) 50, 904-907; doi:10.1038/sc.2012.76; published online 17 July 2012Keywords: urodynamics; neurogenic detrusor overactivity; onabotulinumtoxinA; spinal cord injury; suburothelial injection INTRODUCTION Spinal cord injuries are among the most devastating of all injuries, often having life-changing and diverse consequences. Lower urinary tract dysfunction is commonly observed as a result of a spinal cord injury. Neurogenic detrusor overactivity (NDO) is frequently associated with upper motor neuron lesion, and the subsequent increased intravesical pressure may present a potential risk by causing damage to the upper urinary tract. 1 Current standard NDO treatment comprises individualised administration of anticholinergic medication; however, this therapy is inadequate for some patients and is often associated with unacceptable adverse effects. 2 Treatment with botulinum toxin offers an accepted alternative treatment for those patients in whom anticholinergic treatment has failed.Botulinum toxin is a neurotoxin produced by anaerobic microorganisms of the Clostridium genus. Botulinum toxin acts on the peripheral nervous system where it is responsible for blockade of acetylcholine release from presynaptic nerve endings. 3 This process results in blockade of the neuromuscular transfer, with a subsequent loss of muscle cell contractility.A further effect of botulinum toxin following administra...

Laparoscopic surgery has become a frequently used modality for rectal tumour surgery. A fistula between the rectum and lower urinary tract is one of the possible complications, with rectovesical fistulas occurring most frequently. This case report presents a 66-year-old man who underwent a laparoscopic low-anterior resection of the rectum due to the presence of a polyp with a high risk of malignant transformation. At the time of discharge on the eleventh postoperative day, the patient returned to the hospital with a fever, scrotal swelling and pain in the right hemiscrotum. These symptoms began four hours after discharge from the hospital. There was no sign of faecaluria. The presence of gas in the urinary bladder was confirmed after catheter insertion. The patient was diagnosed with a fistula between the anterior wall of the rectum and seminal vesicles. The diagnosis was based on cystoscopy findings, X-ray and computed tomography irrigography. The condition was treated conservatively by suprapubic insertion of a catheter and antibiotics. The total length of the treatment, including management of subsequent complications, was 4 months. Twelve months after the complication developed, the patient is symptom free, without urinary tract infection recurrence, and is under the care of both surgery and urology clinics. We describe the clinical symptoms, possibilities of treatment and the result of treatment of this rare complication of rectum low-anterior resection, which has never been described in the literature before.

We want to thank Dr Burki and Dr Hamid 1 for positive comments with regard to our study and for their constructive critique. 2 We acknowledge that correct way to express the dose of onabotulinum toxin is using Allergan Units U.We agree that it might be difficult to perform suburothelial injection with absolute certainty in every instance. However, we feel that it is possible to know with certainty that the injection has been performed suburothelialy. As our study had documented that there is no statistically significant difference between the two modes of drug administration, the certainty with regard to the depth of injection is not necessary. We however predict that suburothelial administration is safer than intramuscular, as it is administrated under visual control. Although current study does not include large enough sample size to support this conclusion, we are addressing the complication rate in the ongoing study.With regard to the conflict of interest, we want to confirm our original disclaimer that none of the authors has any conflict of interest. The statement that the second author has been a consultant for Allergan and an invited lecturer for Pfizer, Astellas and Wellspect Healthcare is incorrect. CONFLICT OF INTERESTThe authors declare no conflict of interest.