Reduction in Number of Botox Injections for Urgency Urinary Incontinence

Eligibility Criteria

• * Females at least 21 years of age
• * English speaking
• * Five or more urge urinary incontinence episodes on a three-day voiding diary. Urge incontinence episodes will be determined based on voiding diary and subject indication of coincident urge symptoms, allowing for self-characterization of incontinence type
• * Urge predominant (urge \>50% of total incontinent episodes) urinary incontinence based on self-reported characterization of incontinent episodes on diary
• * Patient or caregiver willing to perform clean intermittent catheterization, or patient willing to have indwelling Foley catheter in the event this would be required
• * Request for treatment for urgency urinary incontinence. The patient may have tried other pharmacologic treatments for urge incontinence, such as antispasmodic agents or non-pharmacologic treatments, such as supervised behavioral therapy, supervised physical therapy, unsupervised physical therapy, supervised biofeedback, and transvaginal electrical stimulation.
• * Subject has undergone 3-week washout period if subject were on anticholinergic therapy prior to enrollment
• * Subject is able to complete all study related items and interviews
• * Willingness and ability to comply with scheduled visits and study procedures.
• * Current symptomatic urinary tract infection that has not resolved prior to randomization.
• * Baseline need for intermittent self-catheterization
• * PVR (Post void residual) \>150 mL on 2 occasions with void(s) of greater than 150 mL
• * Surgical treatment for stress incontinence (sling, Burch or urethral injection) or pelvic organ prolapse recommended or planned at enrollment by study investigator(s).
• * Any prior intra-detrusor botulinum toxin A injections
• * Previous or currently implanted neuromodulation (sacral or tibial).
• * Surgically altered detrusor muscle, such as augmentation cystoplasty.
• * Known allergy to botulinum toxin A.
• * Women with known neurologic disease believed to potentially affect urinary function (history of stroke, Parkinson's disease, multiple sclerosis, spinal cord injuries, myasthenia gravis, Charcot-Marie-Tooth disease).
• * Known allergy to lidocaine.
• * Currently pregnant or lactating patients or patients planning pregnancy within the next year.
• * Sexually active premenopausal women with a uterus who have either not had a tubal ligation or are not on a medically approved form of contraception for at least 3 months prior to and throughout the duration of the study.
• * Cystoscopic findings that preclude injection, in the opinion of the investigator.
• * Current or prior bladder malignancy.
• * Inability to understand diary instructions and complete 3-day voiding diary.
• * Subject has been previously diagnosed with interstitial cystitis or chronic pelvic pain syndrome.
• * Subjects with hematuria who have not undergone a clinically appropriate evaluation.
• * Serum creatinine level greater than twice the upper limit of normal within the previous year.
• * Two or more hospitalizations for medical conditions in the previous years
• * Plans to move out of area in the next 6 months