Background: Local administration of botulinum toxin A (BTX-A) inhibits presynaptic acetylcholine release. It is considered a novel option for the treatment of high pressure bladder.
Case Report: 26 old male suffering from multiple sclerosis, renal insufficiency and hiperkalimia caused by obstruction and small neurogenic bladder with urinary tract infection was presented. Live saving traetment included right percutaneus nephrostomy tube was performed. Patient refused bladder augmentation. He was treated with 3 procedures of botulinum toxin A injections (Dysport). Total dose was 1500 units. This treatment allowed to increase bladder capacity together with improvment of upper tract. Clean Intermitted Catheterization supported with α-blocker (8 mg daily) and oxibutinine (10 mg) daily allowed to prevent incontinence.
Conclusions: Botulinum toxin injections can serve as the first treatment of small spastic bladder even in cases where cystoplasty was usually considered.

Keywords: neurogenic bladder