J Urol Ren Dis, an open access journal ISSN: 2575-7903 1 Volume 2019; Issue 01 Journal of Urology and Renal Diseases Case Report Gillispie G, et al. J Urol Ren Dis: JURD-1133. “Incremental Syringe” A Novel, User-Friendly Syringe to Inject Botulinum Toxin with Improved Accuracy, Precision, and Ease Gregory Gillispie 1 , Christopher McLouth 2 , Philip Brown 1 , Majid Mirzazadeh 3* 1 Department of Biomedical Engineering, Virginia Tech-Wake Forest School of Biomedical Engineering Sciences, Winston-Salem, NC USA 2 Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, USA 3 Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC USA * Corresponding author: Majid Mirzazadeh, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. Tel: +1-3367130324; Fax: +1-3367169916; Email: mmirzaza@wakehealth.edu Citation: Gillispie G, McLouth C, Brown P, Majid Mirzazadeh M (2019) “Incremental Syringe” A Novel, User-Friendly Syringe to Inject Botulinum Toxin with Improved Accuracy, Precision, and Ease. J Urol Ren Dis: JURD-1133. DOI: 10.29011/2575- 7903.001133 Received Date: 18 December, 2018; Accepted Date: 09 January, 2019; Published Date: 15 January, 2019 DOI: 10.29011/2575-7903.001133 Abstract Purpose: Traditional syringes require users to visually estimate the volumes contained within. This is problematic as the user’s vision can be required elsewhere, such as when viewing a monitor during onabotulinumtoxinA injections for the treatment of detrusor overactivity. Visual monitoring can also be insuffcient for procedures requiring high accuracy and/or precision. An incremental syringe, which provides the user with audible and tactile feedback each increment, has been developed to resolve this problem. The purpose of this study was to compare the incremental syringe to a traditional syringe for accuracy and preci- sion. Methods: Fourteen volunteers dispensed eight consecutive 1.0 mL boluses of water using both syringe types and the weight of each bolus was recorded. This experiment was repeated for 14, 18, and 23-gauge needles. Results: Bolus volumes were lower than intended by 3.0% and 2.4% for traditional and incremental syringes, respectively (p = 0.030). The coeffcient of variation was 4.3% for the traditional syringe and 2.0% for the incremental syringe (p < 0.001). Lower variation both between and within operators was found for the incremental syringe by multiple analyses. Conclusions: The incremental syringe’s main advantage is its ease of use without visual monitoring. The results of this study indicate it is at least as accurate and precise as the syringes currently in use, if not more so, making it a promising medical device for the future Keywords: Accuracy; Dosing; Feedback; Medical Device; Precision; Syringe Introduction Detrusor Overactivity (DO) is a common fnding in both neurological disorders such as multiple sclerosis or spinal cord injuries and in other, non-neurological conditions. Patients with DO suffer from both an increased frequency and urgency of urination, high detrusor pressures, and incontinence. These symptoms both detract from patient quality of life and put the upper urinary tract at risk. Traditionally, anticholinergic treatments and more recently β3 agonists are second line of treatment, after conservative measures have failed. However, the common adverse side-effects and patient noncompliance remain major issues. More recently, minimally invasive intradetrusor injections of onabotulinumtoxinA (BOTOX, Allergan Inc.) has been added as the third line of therapy when neuromodulation medications fail, or a patient cannot tolerate them. These injections have been shown in multiple studies to successfully reduce DO and the associated urinary incontinence and as a result have gained widespread acceptance and usage [1,2]. Intradetrusor injection of onabotulinumtoxinA is an effective and overall easy procedure to perform in offce or operating room setting. For this procedure, patients’ bladders are