 Short Title: Botulinum toxin A injections in patients with Fowlers Syndrome Rationale: The department of Uro-Neurology at the National Hospital for Neurology and Neurosurgery attracts approximately 300 new female patients with urinary retention referred from all over the UK a year. A retrospective study showed the commonest diagnosis was a primary abnormality of the striated urethral sphincter or Fowlers syndrome. Fowlers syndrome FS is due to an intrinsic muscle disorder causing the muscle to be in a state of constant contraction and is recognized by needle electromyography EMG of the striated muscle. In the original description the EMG abnormality was frequently observed in women with clinical features of polycystic ovaries, leading to the hypothesis that the electromyographic abnormality was a consequence of a hormonal abnormality, since it is known that the female urinary sphincter is hormonally dependent. The ongoing abnormal EMG activity is thought to lead to a sustained and involuntary contraction of the sphincter that has a secondary effect of inhibiting detrusor contraction. 