Abstract Purpose Intravesical botulinum toxin A (IVB) is a recognized treatment modality in the overactive bladder (OAB). The effectiveness is, however, variable, which may be due to an inadequate or improper technique. The video presented highlights the benefits of using a dye as an adjunct to refine the installation technique.Materials and methods A 12-year-old girl with spina bifida was managed with clean intermittent catheter (CIC) and a single previous IVB procedure for her urinary incontinence based on her urodynamics. Cystourethroscopy using 8/9.8F integrated scope with straight working channel showed normal urethra, ureteric orifices, and bladder mucosa. Dysport® 1000 units (Galderma Laboratories, Zug, Switzerland) was made up to a 20 ml solution to which 1 ml of methylene blue was added. Multiple sites were injected under endoscopic guidance using a Deflux® needle in the submucosal plane above the trigone along parallel rows.Results Over 30 sites could be injected. The blue dye delineates each injection site and extent. This helps prevent injections too close to each other. When the needle is too superficial leakage occurs, which one can recognize early and stop, repositioning the tip deeper. This early detection reduces wastage of the drug. The immediate appearance of a bluish wheal confirms the proper depth.Conclusion All the above aspects improve accuracy and coverage area and may probably translate into better treatment outcomes.
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