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Intrapouch injections of botulinum toxin type A for the management of unit contractions of a continent urinary diversion.

A 43-year-old woman presented with abdominal pain associated with incontinence from her Indiana pouch continent urinary diversion due to significant unit contractions. The patient's symptoms were refractory to conservative management, including oral and intrapouch antimuscarinic agents. Prior to surgical reconstruction, a trial of intrapouch injections of botulinum toxin type A (BT-A) significantly improved both the abdominal pain and the incontinence. The benefit lasted about 6 months and was subsequently repeated for recurrent symptoms. To our knowledge, this is the first reported case of the management of complications of a continent urinary diversion with BT-A injections.