Table 1.

Inclusion and Exclusion Criteria.

Inclusion Criteria Non-pregnant adult female at least 21 years old, with no plans to become pregnant during the course of the trial) and if of child-bearing potential, with a negative pregnancy test, and if sexually active, must be using medically acceptable contraception. ≥ 6 urgency urinary incontinence episodes on a 3-day baseline bladder diary, with these urge incontinence episodes representing greater than 50% of the total incontinent episodes recorded. Willing and able to complete all study related items and interviews. Refractory urgency urinary incontinence: defined as ◦ Persistent symptoms despite at least one or more conservative treatments (e.g. supervised behavioral therapy, supervised physical therapy); and ◦ Persistent symptoms despite the use of a minimum of two anticholinergics, or unable to tolerate medication due to side effects, or has a contraindication to taking anticholinergic/Beta 3 agonist medication. Currently not on an anticholinergic or antimuscarinic/Beta 3 agonist medication (e.g. oxybutynin, tolterodine, darifenacin, trospium chloride, solifenacin-succinate, fesoterodine and/or mirabegron) or be willing to stop medication for 3 weeks prior to completing baseline bladder diary and expected to remain off medications through duration of study. Demonstrates ability (or have caregiver demonstrate ability) to perform clean intermittent self-catheterization. Grossly neurologically normal on exam and no gross systemic neurologic conditions believed to affect urinary function. Urodynamic assessment within the previous 18 months prior to enrollment or done after enrollment, prior to randomization.

Exclusion Criteria Neurologic diseases such as multiple sclerosis, Parkinson Disease, CVA within 6 months prior to enrollment, myasthenia gravis, Charcot-Marie-Tooth disease, clinically significant peripheral neuropathy, and complete spinal cord injury. Untreated urinary tract infection (UTI). Any prior use of either study therapy for treatment of urinary urge incontinence (Botox A® or Interstim®). Current participation in any other interventional research study. PVR >150 ml on 2 occasions within 6 months prior to enrollment (If the PVR value was obtained by ultrasound and was ≥150 ml, the PVR will be confirmed by catheterization which will be the gold standard) Subjects with knowledge of planned MRIs or diathermy. Current or prior bladder malignancy. Surgically altered detrusor muscle, such as augmentation cystoplasty. Subjects taking aminoglycosides. Currently pregnant or lactating. Subjects who are on ambulatory anticoagulant therapy, including aspirin, who are unable to discontinue treatment for 24 hours prior to bladder injection and staged InterStim® procedure. Serum creatinine level greater than twice the upper limit of normal within the previous year prior to enrollment. Surgical treatment for stress incontinence (sling, Burch or urethral injection) or pelvic organ prolapse recommended or planned at enrollment by study investigator(s). Prior stress incontinence or prolapse surgery within the last 6 months prior to enrollment. Allergy to lidocaine or bupivacaine. Prior pelvic radiation. Uninvestigated hematuria. Greater than or equal to Stage III vaginal prolapse as measured by the POPQ. Known allergy to Botox A®. Current use of a vaginal pessary