Neurourological Management After Failed Intradetrusor OnabotulinumtoxinA Injections.

There are more questions than answers in the explanation for failure of onabotulinumtoxinA injection. We need to define what criteria should be used to diagnose it, what local bladder, neurological, or possibly immune phenomena are responsible for it, and the best and safest way to proceed in these vulnerable patients. We propose a management algorithm that may be worth testing at each step in clinical trials.