To evaluate the efficacy and safety of ultrasound - guided transabdominal injection of Botulinum toxin A (BoNT - A) in the treatment of refractory overactive bladder (rOAB). This retrospective cohort study included 64 patients with rOAB admitted to the Department of Urology, the Third People’s Hospital of Hangzhou, from January 2021 to February 2025. They were divided into an observation group (ultrasound - guided transabdominal injection, 32 cases) and a control group (transurethral cystoscopic injection, 32 cases). Both groups received BoNT - A (100 U) intramural injection of the bladder. In the observation group, the injection was performed under real - time ultrasound guidance through the abdominal wall, while the control group underwent the standard cystoscopic injection method. The primary outcome measures included the parameters of the micturition diary (urgency episodes, daytime urination frequency, nocturia episodes) and bladder capacity (initial desire capacity, maximum bladder capacity) before treatment, 1 month, and 6 months post-treatment. The secondary outcomes covered the standardized scale scores of patients (ICIQ - OAB, OAB - Q), global impression of improvement (PGI - I), visual analog pain score (VAS), incidence of complications, retreatment rates, and immediate willingness to repeat the procedure. There were no statistically significant differences in baseline characteristics (age, sex, and pre - treatment symptom scores) between the two groups (all P > 0.05). After treatment, both groups of patients showed significant improvement in urgency episodes, daytime urination frequency, nocturia episodes, bladder capacity, and ICIQ - OAB and OAB - Q scores (all P < 0.05), but there was no significant difference in therapeutic effects between the groups (all P > 0.05).Six months after treatment, the observed indicators in the observation and control groups increased compared with 1 month after treatment, but were still significantly better than the baseline level (all P < 0.05). There was no significant difference in efficacy between the two groups (all P > 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P < 0.01), and the VAS pain score was lower (3.32 ± 1.25 vs. 4.82 ± 1.61, P = 0.006), with a higher immediate willingness to repeat the procedure (8.28 ± 1.54 vs. 6.86 ± 2.19, P = 0.004). There was no significant difference in PGI-I scores between the groups (2.27 ± 0.92 vs. 1.95 ± 0.43, P = 0.08). There was no significant difference in the repeat injection rate between the two groups at 6 months after treatment (28.13% vs. 18.75%, P = 0.375). Ultrasound - guided transabdominal injection of BoNT - A for rOAB is as effective as transurethral cystoscopic injection, but it can significantly reduce the risk of complications and improve patient acceptance of treatment, providing a safer and more compliant alternative option for clinical practice.

To investigate the effect of sacral nerve root magnetic stimulation(SMS) on bladder urodynamics and M3 receptor expression in rats with neurogenic bladder. 30 adult female SD rats were randomly divided into Normal Group, Model Group, and Magnetic Stimulation Group, with 10 rats in each group. The Model Group and Magnetic Stimulation Group used the spinal cord transtion method to establish the neurogenic bladder animal model. After successful modeling, the Magnetic Stimulation Group received magnetic stimulation treatment once per day for 8 consutive weeks. After 8 weeks, bladder urodynamics were measured under anesthesia, rats were sacrificed, and bladder detrusor muscle tissue was collected for histological and ultrastructural observation, and M3 receptor expression levels were measured. The maximum bladder capacity and bladder compliance in the Magnetic Stimulation Group were higher than those in the Model Group (all P < 0. 05), and the leak point pressure was lower than that in the Model Group (P < 0. 05); there were no significant differences between the Magnetic Stimulation Group and the Normal Group in these three parameters (all P > 0. 05). H&E staining of bladder detrusor muscle tissue in the Magnetic Stimulation Group revealed minimal neutrophil infiltration. Moreover, the morphology and arrangement of the mucosal epithelial cells were closer to those observed in the Normal Group when compared with the Model Group. Under transmission electron microscopy, detrusor muscle cells had a smooth surface, slightly widened intercellular spaces, relatively uniform arrangement, and relatively intact mitochondrial structure. The expression level of M3 receptors in the bladder detrusor muscle tissue of the Magnetic Stimulation Group was significantly higher than that in the Normal Group and the Model Group (all P < 0. 05); there was no significant difference between the Model Group and the Normal Group (P > 0. 05). Sacral nerve root magnetic stimulation has a certain effect on improving bladder function in rats with neurogenic bladder, which may be related to the increased expression level of M3 receptors in the bladder detrusor muscle tissue.

To compare the efficacy and safety of ultrasound-guided transabdominal versus transurethral cystoscopic botulinum toxin type A (BoNT-A) injection for treat