Intradetrusor injection of botulinum toxin A and sacral neuromodulation for neurogenic detrusor overactivity.

Intradetrusor injection of botulinum toxin A and sacral neuromodulation are the two recommended third line treatments for patients with neurogenic detrusor overactivity, before undergoing with surgery. However, only Botox® injection is supported by a high level of evidence allowing its recommendation by all institutional guidelines. Despite few positive results, sacral neuromodulation should be proposed in carefully selected patients. Indeed, other studies remain mandatory to increase its level of evidence necessary for allowing its use in neurogenic detrusor overactivity.