الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Overactive bladder was recently defined by the involuntary
detrusor contraction (ICS) as “urgency, with or without urge incontinence, usually with frequency and nocturia . . . if there is no proven infection or other obvious pathology.OAB may be neurogenic or idiopathic. We consider overactive bladder to be a symptom complex (syndrome). Overactive bladder syndrome (OAB) has socioeconomic impact with significant impairment in quality of life. Men and women had the same prevalence of OAB overall (16.0% and 16.9% respectively) as defined by the ICS with prevalence increase by age.
Behavioral Modifications, bladder retraining and Pelvic Floor Muscle Retraining are recommended first-line treatment by The American Urological Association (AUA) and Society for Urodynamics. Pharmacological management with an oral anticholinergic or oral β3-adrenoceptor agonist is considered second line. Refractory OAB could be defined as persistent urgency, frequency, with or without incontinence that remains bothersome despite adequate behavioral and medical therapy with at least one medication administered for 4 to 8 weeks.
Refractory OAB is treated using the third line therapy which include: BTX-A injection, SNM and PTNS
In this study we evaluated the safety and efficacy of BTX injection into the bladder in subjects suffering refractory OAB.
This is a randomized study that was approved by the local ethical committee, Faculty of Medicine, Assiut University. Subjects with refractory OAB attending the Female Urology and neurourology unit outpatient Clinic, Assiut Urology and Nephrology Hospital (AUNH) were approached and invited to participate in the study.22 patients with refractory OAB (15 patients with idiopathic OAB received BTX-A 100 U intradetrusor injection and 7 patients with neurogenic OAB received BTX-A 200 U intradetrusor injection)
The patients evaluated after 12 and 24 weeks using UDI-6, IIQ-7 and voiding diary ,urine analysis and sonar to assess PVR.