OBJECTIVES: To evaluate treatment outcomes, medical care and resource consumption of patients with neurogenic detrusor overactivity (NDO) before and after botulinum toxin A (BTA) therapy in Germany. METHODS: In a multi-center, cross-sectional, retrospective cohort study, information such as demographic characteristics, number of BTA therapies, urodynamic parameters, occurrence of urinary tract infection (UTI), number of incontinence episodes, use of incontinence aids (e.g. absorbent pads, urinary reservoirs) frequency and number of outpatient consultations were collected by chart abstraction covering 12 months before and after first BTA therapy. RESULTS: Seven specialized hospitals enrolled 214 patients who received in total 418 BTA therapies between 2000 and 2006. Mean age was 38 years (SD 15), 68% were male. Seventy-seven percent suffered from NDO due to spinal cord injury, 14% due to spina bifida and 5% due to multiple sclerosis. Within 12 months 51% of patients received one BTA therapy, 41% two and 8% three BTA therapies. On average, time interval between BTA therapies was 8.0 months (SD 4.2). Within 12 months before first BTA therapy 63% of patients had incontinence episodes and 68% of patients UTI, after BTA therapy 28% and 33%, respectively. Incontinence aids were used by 58% of patients within 12 months before first BTA therapy and in 28% of patients after BTA therapy. In patients, who had used incontinence aids, mean cost per day and patient decreased from €2 (SD 2) to €1 (SD 2). Mean drug cost per patient to treat UTI within 12 months decreased from €163 (SD 242) before treatment to €80 (SD 142) after the start of BTA therapy. CONCLUSION: Presented data are the first data showing the clinical usefulness of botulinum toxin A under naturalistic conditions in Germany. Moreover, occurrence of incontinence and UTI was reduced resulting in lower cost for incontinence aids and UTI medication.