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Neurogenic urinary incontinence often results from loss of supraspinal inhibitory input that leads to involuntary bladder contractions (detrusor hyperreflexia). Recently, a novel approach has been used to “chemically” denervate the bladder. Botulinum-A toxin has been injected cystoscopically into neurogenic patients' bladder to treat refractory detrusor hyperreflexia and neurogenic incontinence. Reflex voided volumes, bladder capacities, and compliance increased while maximum detrusor pressures decreased. Continence was maintained for up to 6 months with anticholinergic agents eliminated or greatly reduced. Botulinum-A toxin detrusor injection appears to be a safe, minimally invasive, reversible, and effective treatment option for controlling detrusor hyperreflexia.