Expansion of onabotulinumtoxinA (BoNT-A) application has revolutionized the treatment algorithms associated with idiopathic and neurogenic lower urinary tract symptoms. Dominant to this increased utilization is the relative ease of administration and low complication profile. However, concerns for systemic spread and local ramifications such as infection and urinary retention mandate exceptional vigilance from the treating urologist. Careful attention to the potential sequela of BoNT-A therapy will ensure patient outcomes more closely match expectations.