In this section, many different issues are written about by authors from the UK, France, the Netherlands, the USA and Denmark, respectively. Topics covered are botulinum toxin in drug‐resistant neurogenic detrusor overactivity in spinal cord injury, dutasteride and BPH, the effect of childbirth on bothersome LUTS, female urethral strictures, and a new bulking agent in treating female stress urinary incontinence. OBJECTIVES To assess, in a prospective study, whether botulinum toxin‐type A (BTX‐A) injected into the detrusor muscle, can be used as a day‐case treatment for drug‐resistant neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI). PATIENTS AND METHODS BTX‐A (Dysport, Ipsen, Luxembourg; 1000 units) was injected cystoscopically into the detrusor muscle of 37 patients with drug‐resistant NDO and SCI, as a day‐case procedure. The maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), NDO, continence, and anticholinergic requirement were used as outcome variables. The International Consultation on Incontinence questionnaire (ICIQ) was used to assess the patient’s quality of life before and after the BTX‐A injection. RESULTS The mean follow‐up was 7 months. The MCC increased from a mean of 259 to 522 mL, and the MDP decreased from a mean of 54 to 24 cmH2O. Incontinence and NDO were abolished in 82% and 76% patients, respectively. In all, 86% of the patients were able to stop or reduce anticholinergics, with a similar proportion of patients scoring favourably on the ICIQ. The mean duration of improvement was 9 months. CONCLUSIONS Injection with BTX‐A is an effective day‐case treatment that bridges the gap between oral and invasive surgical treatment of drug‐resistant NDO in patients with SCI.

Introduction:  We evaluated safety and long‐term efficacy of TVT in treatment of urodynamic stress incontinence (USI) in females with neuropathic bladders. Method:  Sixteen incontinent female patients were treated. 11 women were postlumbar spinal surgery and five postspinal cord injury. Four had previously failed surgery for USI. Patient demographics, pre and postoperative clinical and videocystometrogram (VCMG) parameters were recorded. Continence assessment at 6 weeks (voiding diary and pad test), 3 months (VCMG) and yearly follow up was recorded. Results:  Mean age was 55 years with mean follow up of 52.7 months (range 12–86). At last follow up 87.5% patients (14/16) were continent. The two failures were due to persistent USI and postoperative detrusor hyperreflexia (DH). DH was pre operatively present in 4, requiring simultaneous intra detrusor botulinum toxin injections in two and anticholinergic medications in rest. Bladder perforation was seen in one and urinary infections in three. Mean pre and postoperative detrusor pressures were 23.8 and 15 cm of water. Two patients continued to use pads (3/day) similar to pre operative cumulative average of three pads/day. Preoperatively 11 patients performed intermittent catheters (SIC), three spontaneous voids (SV) and one combination of the two with one on indwelling urethral catheter (IDUC). One patient each on SV, SIC and IDUC changed to SIC. Conversely one each on SIC and SV changed to combination. Conclusion:  TVT is safe, effective long‐term treatment for USI in females with neuropathic bladders. DH needs adequate suppression with regular VCMG follow up. Previous incontinence surgery did not affect complications or outcome.

We prospectively assessed the efficacy of simultaneous ID BTX injections and transobturator (TOT) and tension free vaginal tapes (TVT) in SCI women refractory or intolerant to anticholinergics. Five SCI women with urodynamically proven mixed incontinence were treated with simultaneous suburethral sling and BTX injections. TVT or TOT followed ID injection of 1000 units of English BTX in the same sitting. Patient demographics, pre and postoperative quality of life score, clinical and videocystometrogram (VCMG) parameters were recorded. Continence was assessed at 6 weeks (voiding diary and pad test), 3 months (VCMG) and then yearly. There were no immediate or long‐term complications. TVT was performed in three (two thoracic and one lumbar SCI) and TOT in two (one thoracolumbar and one lumbar SCI). Sustained improvement was seen in all clinical parameters starting from 6 weeks till the last follow up at a mean of 13.8 months. All patients were dry with improved quality of life. Corresponding changes were seen on VCMG. (Table). Mixed incontinence in SCI women refractory or intolerant to anticholinergics can be treated with simultaneous ID BTX injections and TOT or TVT with high cure and satisfaction rates. Pt. No. MCC (ml) MDP (cm of water) Detrusor hyperreflexia USI PrePostPrePostPrePostPrePost11104203316YesNoYesNo22604503818YesNoYesNo35007009320YesNoYesNo42254127442YesNoYesNo53506254615YesNoYesNo