Intradetrusor onabotulinumtoxinA therapy has proven effective in decreasing episodes of urgency urinary incontinence and improving quality of life in patients with refractory idiopathic and neurogenic detrusor overactivity. While the definition and reporting of urinary tract infections as well as dosing of onabotulinumtoxin varied across trials, there was a demonstrated increased risk of developing a urinary tract infection with onabotulinumtoxinA injections when compared to placebo injection. Occurrence of urinary tract infections was found to persist through multiple treatment cycles, while the rates of catheterization seem to decrease with subsequent treatments. While multiple theories exist, the current literature has not been able to elucidate the mechanism by which intradetrusor onabotulinumtoxinA injections increase the risk of urinary tract infections.