Hazard of botulinum toxin type A injection into the detrusor in patients with an artificial urinary sphincter

We performed a retrospective chart review of two patients with a previously implanted artificial urinary sphincter (AUS) who became incontinent after the injection of botulinum toxin type A into the detrusor. Two prepubertal males with a myelomeningocele, neuropathic bladder and urinary incontinence developed bladder hypertonicity. Treatment by botulinum toxin type A injection into the detrusor resulted in a loss of fluid from the balloon and recurrent incontinence. This method of treatment in patients with a previously implanted AUS should be avoided, as not only does it appear to be of only temporary benefit, but also as demonstrated by these cases it can damage the AUS system.