Treatment of overactive bladder (OAB) has a wide spectrum. The first step is lifestyle modifications, the second step is pharmacotherapy and the third line is intradetrusor injections with Botox®. This retrospective study is from Tennessee, USA in non-neurogenic and refractory OAB. One hundred and sixty patients were included: female to male ratio was 76% to 24% and the average age was 64 +/- 13.2. All patients underwent urodynamics. Postoperatively 35% cases had retention requiring clean intermittent self-catheterisation (CISC). Sixteen percent had infections while 74% had improved urgency incontinence. Predictive factors in Botox therapy are identified as: 1) preoperative post void residue (PVR), 2) bladder capacity, 3) number of times Botox used. As more and more units in the UK and Europe are using Botox, this study will be of interest to urologists, trainees and nurse specialists, with obvious resource and cost implications.