A PHASE III, MULTICENTRE, RANDOMISED, DOUBLE BLIND, PARALLEL GROUP,
PLACEBO CONTROLLED STUDY TO ASSESS THE EFFICACY AND SAFETY OF
ONE OR MORE INTRADETRUSOR TREATMENTS OF 600 OR 800 UNITS OF
DYSPORT® FOR THE TREATMENT OF URINARY INCONTINENCE IN SUBJECTS
WITH NEUROGENIC DETRUSOR OVERACTIVITY DUE TO SPINAL CORD INJURY
OR MULTIPLE SCLEROSIS

1) Written informed consent prior to any study-related procedure.
2) Male or female, aged 18 to 80 years inclusive.
3) UI for at least 3 months prior to Screening as a result of NDO due to SCI or MS.
4) Subjects with SCI must have a stable neurological injury at T1 level or below which
occurred at least 6 months prior to Screening.
OR
Subjects with MS must be clinically stable in the investigator*s opinion, with no
exacerbation (relapse) of MS for at least 3 months prior to Screening.
5) Subjects must have had an inadequate response after at least 4 weeks of oral
medications used in the treatment of NDO (e.g. anticholinergics, beta-3 agonists)
and/or have intolerable side-effects.
6) Subjects who are to continue on concomitant oral medications for NDO during the
study must be on a stable dose for at least 4 weeks prior to Screening.
7) Subjects who are to continue on concomitant oral medications for NDO during the
study must be willing to continue on the same medications and doses during
Screening and for at least 12 weeks following the first IMP administration.
8) Routinely performing CIC to ensure adequate bladder emptying (regularly
performing CIC at a regimen of every 4*6 hours during waking hours, or more
frequently). CIC regimen must be stable for at least 4 weeks prior to Screening (CIC
may be performed by the subject or caregiver).
9) Subjects must be willing to continue on the same CIC regimen during Screening and
for at least 12 weeks following the first IMP administration.
10) Female subjects of childbearing potential must have a negative pregnancy test result
and be willing to use reliable contraceptive measures throughout study participation.
Reliable forms of contraception include but are not limited to:
* hormonal contraceptives (e.g. oral, patch, injection)
* double barrier (e.g. male condom plus spermicide, or female diaphragm plus
spermicide)
* intrauterine device
* male partner has had a vasectomy
* total abstinence from intercourse with male partners (periodic abstinence is not
acceptable).
Female subjects meeting any of the following criteria are not considered to be ofchildbearing potential:
* postmenopausal (*47 years of age and amenorrhoeic for at least
12 consecutive months)
* have been sterilised surgically (e.g. bilateral tubal ligation)
* have had a hysterectomy
* have had a bilateral oophorectomy.
11) Documented urinary tract ultrasound is available in the 6 months prior to Screening,
confirming that no medical issues exist that would preclude entry to the study (e.g.
bladder stones or unexplained renal mass).
* If not performed in the 6 months prior to Screening or results are not available,
then a urinary tract ultrasound must be conducted during Screening.
12) Ability to complete all study requirements in the opinion of the investigator,
including regularly completing the 7-day bladder diary and attending all scheduled
study visits. The caregiver may assist with the completion of study documentation
and procedures (including the bladder diary and questionnaires), if required.
The following inclusion criteria will be assessed following completion of screening bladder
diary:
13) An average of at least two episodes per day of UI recorded on the screening bladder
diary.
14) No more than two incontinent-free days documented on the screening bladder diary.
The following inclusion criterion will be assessed following completion of screening
urodynamic assessment:
15) NDO (defined as the presence of involuntary detrusor contractions (IDCs) during the
storage phase of urodynamic filling cystometry).

1) Any current condition (other than NDO) that may impact on bladder function,
including but not limited to:
* predominant stress UI (rather than NDO-related incontinence)
* bladder stones
* current symptomatic urinary tract infection
* current active genitourinary infection, e.g. genital warts
* uterine prolapse
* cystocele
* rectocele.
Mild uterine prolapse, cystocele or rectocele that does not impact on bladder function
is not exclusionary.
2) Previous or current, tumour or malignancy affecting the spinal column or spinal cord,
or any other nonstable cause of SCI.
3) Surgery less than 6 months prior to Screening for bladder stones.
4) Surgery less than 6 months prior to Screening for uterine prolapse, cystocele or rectocele.
5) Previous open surgery for NDO, e.g. augmentation cystoplasty.
6) Previous urethral stent placement or sphincterotomy.
7) Previous or current diagnosis of, or symptoms/signs/investigations suggestive of,
significant urological or pelvic disease, including but not limited to:
* urinary tract malignancy (e.g. bladder, prostate, urethral or kidney cancer)
* hydronephrosis
* interstitial cystitis/bladder pain syndrome
* müllerian duct cysts
* radiation cystitis
* genitourinary tuberculosis.
8) Previous or current uninvestigated haematuria. Subjects with investigated haematuria
may enter the study if significant urological/renal pathology has been ruled out to the
satisfaction of the investigator.
9) Any condition that will prevent cystoscopic treatment administration or CIC usage,
e.g. urethral strictures.
10) Current indwelling bladder catheter, or removal of indwelling bladder catheter less
than 4 weeks prior to Screening.
11) BTX-A treatment within 9 months prior to Screening for any urological condition
(e.g. detrusor or urethral sphincter treatments).
12) BTX-A treatment within 3 months prior to Screening for any non-urological
condition.
13) Bladder instillation with any pharmacologic agent less than 3 months prior to
Screening.
14) Use of capsaicin or resiniferatoxin less than 6 months prior to Screening.
15) Any neuromodulation/electrostimulation usage for urinary symptoms/incontinence
within 4 weeks prior to Screening. Any implanted neuromodulation device must be
switched off at least 4 weeks prior to Screening and must remain off throughout
study participation.
16) Any concomitant therapy usage that, in the investigator*s opinion, would interfere
with the evaluation of safety or efficacy of the IMP, and/or confound the study
results.
17) History of chronic drug or alcohol abuse.
18) Female subject who is pregnant or planning to become pregnant during the study, or
is currently lactating (breastfeeding).
19) Any medical condition or disease that might interfere with neuromuscular function,
e.g. diagnosed myasthenia gravis, Lambert-Eaton syndrome or amyotrophic lateral
sclerosis.
20) Use of medications that affect neuromuscular transmission, such as curare-like
depolarising agents, lincosamides, polymyxins, anticholinesterases and
aminoglycoside antibiotics.
21) Previous primary or secondary non response to any botulinum toxins for the targeted
condition.
22) Known hypersensitivity to BTX-A or to any components in the IMP formulation
(including cow*s milk protein).
23) History of allergy to, or intolerance to, the anaesthetic or antibiotic agents that the
investigator intends to use during the study.
24) Unable to stop medications with anticoagulant/antiplatelet effects for at least 3 days
prior to each IMP administration and to recommence the day following each
IMP administration (low molecular weight heparins may be used within 3 days of
IMP administration).
25) Any condition that may cause excessive bleeding (e.g. haemophilia or clotting factor
deficiencies).
26) Any condition or situation which, in the investigator*s opinion, puts the subject at
significant risk, may confound the study results, or may interfere with the subject*s
participation in the study.
27) Treatment with any new investigational drug or device in the 4 weeks prior to
Screening or scheduled to be used during the study period. In addition, at least
5 elimination half-lives must have occurred since discontinuing any new
investigational drug prior to Screening.
The following exclusion criteria will be assessed following completion of screening bladder
diary and when screening laboratory blood results become available:
28) Voided urine volume *3 L during a single 24-hour period on the screening bladder
diary.
29) Serum creatinine *2 times the upper limit of normal on screening serum chemistry
testing.