Complication of botulinum-A toxin treatment of neurogenic detrusor overactivity in a patient taking oral anticoagulation therapy: Massive hematuria

A 22-year-old male with a spontaneous spinal epidural hematoma with a mechanical aortic valve taking warfarin is presented in this article. An important problem for the patient was urinary incontinence which resulted from detrusor overactivity resistant to anticholinergic therapy. Botulinum-A toxin was injected into the detrusor muscle of this patient. Three days after botulinum-A toxin injection, macroscopic hematuria developed. International normalized ratio (INR) was 1.7. Massive hematuria resolved completely four days later. It is the first reported case where botulinum-A toxin injection into the detrusor muscle resulted with massive hematuria as a complication. It can be recommended that warfarin should be stopped and low molecular weight heparin should be started in this population before botulinum - A toxin injections into the detrusor muscle.