الفهرس 
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Abstract
Background: Overactive bladder (OAB) is a condition characterized by the presence of urinary urgency, typically combined with frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of UTI or other clear pathology (Haylen et al., 2010).Bladder and behavioral training, pharmacological treatment and surgical therapies are different treatment options for OAB (Wein and Rackley 2006). However, their use is limited in some patients by insufficient response to treatment, i.e. ‗refractory OAB‘, or by intolerable side-effects such as dry mouth, blurred vision, constipation, and cognitive impairment (Wein and Rackley 2006). The aim of the work: The aim of our study is to find an additive methods to increase the urothelial permeability to BoNT-A absorption without the need for injection in the treatment of OAB. Based on a recent experimental study that proved that LESWs exposure temporarily increased urothelial permeability and facilitated delivery of intra vesical botulinum toxin without the need for injection in rats (Chuang et al., 2016). Patients: our thesis done to conduct a feasibility study that included 2 phases: Phase I : experimental study on rats Phase II : A pilot preliminary study in a small group of human volunteers to assess the effectiveness of that new technique. Methods In the phase I study, 40 rats were subdivided into four equal groups: normal control group, OAB group, LESW group and BoNT-A plus LESW group. Cystometrogram (CMG) measuring amplitude and frequency of detrusor contraction and histopathological changes in the bladder mucosa were assessed in the different groups. Oxidative stress markers (MDA and SOD) and pro- inflammatory cytokines (TNF-α and IL-6) were compared among groups.In the phase II study, a preliminary clinical study was conducted, including 15 patients with refractory OAB. Intravesical instillation of 100 IU of BoNT-A was done followed by LESWs (3000 shocks over 10 min) exposure to the suprapubic area. Patients were followed-up by urine analysis, urine culture, post-void residual urine volume (PVR), and Overactive Bladder Symptom Score (OABSS) at 1, 2 and 3 months. Results& Conclusion: Intravesical instillation of BoNT-A with LESW seems to be a good alternative to intradetrusor injection of BoNT-A in management of refractory OAB. It is safe and effective for 2 months. The effect is not durable due to the inadequacy of the dose of BoNTA and/or non-optimised LESW technique. Much more studies are required. Recommendations: Much more studies are required.