**7.4 Use of botulinum toxin a in the of overactive bladder**

Patients who has refractory overactive bladder symptoms are over by clinicians Botulinum toxin A by the clinician and at this stage the patient case would have have had urodynamic studies that confirms detrusor overactivity and have her case discussed in the multidisciplinary team meeting that include urogynaecologist, urogynaecoogology nurse Specilaist, phythiotherapist and may include also a urologist [19].

Botulinum toxin A is an extremely potent neurotoxin and its Intravesical injection under local or general anaesthesia via cystoscopy improves the over active bladder symptoms up to 90%. The most commonly applied regimen is use of 100 units of botox in 20 injection points through the bladder sparing the trigone area. The effect of botox injection wears off in 3–12 months depends on the severity of overactive bladder symptoms. Approximately 5–10% of patients receiving botox injection can develop urine retention postoperatively and hence preoperative teaching of the patient how to self catheterise and empty the bladder twice a day is very important [20–22].

The role of urogynaecology nurse at this stage is participating in patient education about about the botox benefits and help the patient to obtain the relevant information leaflets. Also, nurse specialist should be able to teach the patient self catheterisation and ensure it is done promptly especially in old patients with joint movement or rheumatoid arthritis difficulty who has difficulty in reaching out to able to self catheterise. In tertiary units with cavities of training and supervision urogynaecology nurses can perform outpatient cystoscopic botox injection.
