This is one of the longest follow-up studies of botulinum toxin A usage in children with bladder dysfunction in the paediatric literature. Fifty-three children had Botox® (Allergan) injected for a variety of reasons (spina bifida – 18, acquired cord injury – 4, cerebral palsy – 3, transverse myelitis – 1, intraspinal lipoma – 1, post pelvic surgery retention – 1, acquired brain injury – 1, idiopathic – 24). A total of 134 injections were administered (106 intravesical, 23 intrasphincteric, 5 combined). The mean injection number was 2.57 (range 1-11). Mean follow-up was 26-79 months (range 3-93). The dose used was 10IU/kg to a maximum of 300IU. Follow-up was clinically of non-invasive bladder assessment with flow rate, residual volumes and measures of incontinence. Good responses were gauged using the International Continence Society treatment response scale. Follow-up occurred at three to six monthly intervals. There were 16 minor complications after the 134 injections (urinary tract infection – 13, retention – 3). Of the 37 children who underwent injection because of detrusor overactivity (22 neurogenic DO, 15 idopathic DO), all responded with a >90% reduction in symptoms and the median response time was seven months (0-25) for the NDO and just over five months (0-15) for the IDO. Of the five who had intrasphincteric injections for retention, one had complete resolution, two had short-term improvement for between one and three months, and two had no response, remaining in retention. The authors conclude that intravesical onabotulinumtoxinA injection remains efficacious in children for up to 11 injections and may be used for non standard therapeutic indications safely.