Botulinum toxin is an accepted therapy for several urologic diseases involving the lower urinary tract system. Intravesical injection of the toxin emerged in recent decades as an evidenced-based approach for the treatment of patients with medication refractory neurogenic or idiopathic detrusor over-activity. The use of the toxin for other urologic disease such as benign prostate enlargement, detrusor-sphincter dyssynergia or premature ejaculation - still requires further research.