COMMENT The prevalence of double incontinence among Brazilian women is 4.9% and its incidence in the period between 2006 and 2010 was 13.8/1000 person/year (1) In fact, evacuatory and even sexual symptoms are usually underestimated in urological consultations related to overactive bladder (OAB) symptoms. In those women with refractory OAB, the coexistence of these dysfunctions may be even greater. The effects of sacral neuromodulation (SNM) on fecal incontinence are well known, so that this

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... tment represents an important therapeutic option in double incontinent patients. On the other hand, the therapeutic mechanism of intravesical injection of botulinum toxin (BTX) is much less understood. In this prospective randomized study, the authors performed a post-hoc analysis of data from the ROSETTA trial (2), which included women with refractory urinary incontinence treated with BTX-A (n: 190) or SNM (n: 174). Urinary incontinence and sexual symptoms were evaluated for up to 24 months using the Pelvic Organ Prolapse / Urinary Sexual Incontinence Questionnaire -12 (PISQ-12), IUGA -Revised (PISQ-IR) and St Mark's (Vaizey) Fecal Incontinence Severity Scale. The incidence of fecal incontinence (Vaizey score > 12) did not differ between study groups (BTX: 7.6+5.3 versus SNM: 6.6+4.9, p = 0.07), as did the frequency of sexually active women. Serial evaluations performed after 6, 12, and 24 months post treatment showed improvement of FEMALE UROLOGY