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Objective: To present the initial results of Botulinum-A toxin (BTA) injection in patients with long-standing multiple sclerosis (MS) and urethral leakage of urine in spite of indwelling suprapubic catheters (catheter bypassing). Methods: Study of three patients treated with cystoscopic injection of BTA IU (Allergan). Telephone interviews were made at four- to six-week intervals. Continence status and patient satisfaction were recorded before and after treatment. Results: Patient 1 remained dry at 48 weeks post injection. Patient 2 became incontinent again after 40 weeks. The third patient was continent when interviewed at 27 weeks following injection, but died two weeks later. The patients were very satisfied with the procedure and there were no complications related to BTA. Conclusions: Intradetrusor BTA injection is a very effective and safe treatment for intractable catheter bypassing in patients with neurogenic detrusor overactivity.