Ingham J, et al. - Experts conducted a study to assess the optimum dose success rates, duration of effect, complications and medium-term outcomes of botulinum toxin-A (BtA) in symptomatic refractory patients. In 46% of children, BtA improves symptoms following the first injection in refractory idiopathic overactive bladder (IOAB). Nonetheless, greater increase in bladder capacity was resulted by high dose BtA at 10 units/kg (maximum 300 Units) (HDBtA), no advantage was conferred by it in terms of success rate or duration of response. Since some patients may require a higher dose and some a dose smaller than 5 units/kg, therefore the an optimum dose to use as a first treatment was considered to be 5 units/kg. Urine stasis and UTIs caused by PVR are more likely to be caused by a higher dose. Findings suggested that only till the effect of the BtA wears off, its success lasts. Continuing treatment with repeat BtA or anti-cholinergic agents was required by the majority of this cohort (36/39). Nonetheless, in patients who are intolerant or unresponsive to anti-cholinergic medication with symptomatic resolution in 30% at medium-term follow up, it remains a useful option.