I have experienced some incontinence for quite a few years.in 2018 a urologist tried 3 different pill prescriptions and botox injections in my bladder, none worked. recently an mri showed periventricular leukomalacia.what should i be doing if anythin?

The incontinence is not obviously related to the MRI findings. Consult a urogynecologist, which is a gynecologic subspecialist with expertise in managing such problems. There are certainly possible management options beyond prescriptions and Botox.

Although the brain pathology on MRI is not the direct cause of your bladder issues, nonetheless it is an important co-morbidity finding. This may be due to hypertension, but could also be associated with microvascular angiopathy. Have a medical neurologist assess this further, as stroke risk needs to be addressed.