Botulin-A Toxin/Dimethyl Sulfoxide Bladder Instillations for Treatment of Voiding Dysfunction Secondary to Detrusor Hyperreflexia and Detrusor Instability in Women

Inclusion Criteria:

1. Female patient aged 18 years or older

2. Patient with a history of stress urinary incontinence for at least 12 months

3. Patient with Intrinsic Sphincter Deficiency who demonstrate an abdominal leak point
pressure of less than 100 cm of water on urodynamic evaluation

4. Patient with urinary incontinence verified by the Provocation test: a mean urinary
leakage of 10 g on screening and baseline visits

5. Patient with positive stress test and/or urodynamic stress incontinence

6. Patient who has failed prior non-invasive treatment (e.g. behavior modification,
pelvic floor exercises, biofeedback, electrical stimulation and/or drug therapy)

7. Patient with negative Contigen skin test during screening.

8. Patient who is mentally competent with the ability to understand and comply with the
requirements of the study

9. Patient who agrees to be available for the follow-up evaluations as required by the
protocol

10. Patient who has given signed informed consent

Exclusion Criteria:

1. Patient with Q-tip angle greater than 30 degrees

2. Patient with Functional Bladder capacity <200 ml as recorded in the baseline Bladder
Diary

3. Patient with Post-Void Residual Urine (PVRU) greater than 100 ml on repeated
measures. (Patient with a single PVRU of >100 ml and followed by two consecutive PVRU
measurements of <100 ml may be included in the study)

4. Patient with vesicoureteral reflux, interstitial cystitis, genitourinary fistulae

5. Patient with predominant urge incontinence

6. Patient with detrusor overactivity on filling cystometry

7. Patient with pelvic organ prolapse stage III or IV, i.e. the most distal part of the
prolapse protruding more than 1 cm beyond the hymen (>+1), at straining

8. Patient with urinary incontinence due to neurological disease that is known to affect
urinary tract infection

9. Patient with univestigated hematuria

10. Patient with genitourinary malignancies

11. Patient on current medication for stress urinary incontinence, such as
alpha-adrenergic agonists or duloxetine, within three weeks prior to completing the
baseline Bladder Diary (estrogen therapy on a stable dose for at least two months
prior to study start is allowed)

12. Patient who has had bulking therapy for stress urinary incontinence

13. Patient with ongoing complications of prior anti-incontinence surgery

14. Patient who is pregnant, lactating, or planning to become pregnant within the study
period

15. Patient who has received pelvic radiation

16. Patient with any condition, which could lead to significant postoperative
complications, including current infection and uncontrolled diabetes.

17. Patient who is morbidly obese (defined as BMI > 32 Kg/m2)

18. Patient who is bedridden, institutionalized or in such physical condition that she
cannot move to the closest bathroom without assistance from another person

19. Patient with current or acute urinary tract infection, including cystitis or
urethritis. (Patient with such infections should be treated with antibiotics, with
subsequent urinalysis tests confirming the absence of such infection before study
inclusion)

20. Patient with any condition that would preclude treatment due to contraindications
and/or warnings in the study product's labeling

21. Patient on concomitant medication with anticoagulant properties (e.g., Warfarin,
Heparin, Aspirin, NSAIDs, except for cox-2 inhibitors) within two weeks prior to
treatment

22. Patient on immunomodulatory therapy (suppressive or stimulatory)

23. Patient with a known allergy to bovine collagen

24. Patient with known lidocaine hypersensitivity or hypersensitivity to any anesthetics
to be used during the treatment session/surgical procedure

25. Patient with a concurrent use of another study product within two weeks prior to
study start, or who concurrently participate in any other clinical study

26. Any disease that in the opinion of the Investigator would make the patient unsuitable
for the study

27. Patient with a life expectancy of less than 12 months