Urinary tract infections (UTIs) remain among the most common bacterial infections worldwide, affecting millions every year. While Escherichia coli (E. coli) is the predominant pathogen, a broad range of Gram-negative and Gram-positive organisms can be implicated. Treating UTIs, particularly complicated or severe infections, frequently relies on broad-spectrum antibiotics, often started empirically before identifying the causative pathogen. However, despite their ability to cover a wide spectrum of pathogens, they have become a growing threat to public health, mainly due to the rise of antimicrobial resistance, but also due to the many other adverse effects they can potentially cause. Neurotoxicity represents one of the most consequential yet underrecognized complications of antibiotic therapy. Broad-spectrum agents commonly used for UTIs, including fosfomycin, fluoroquinolones, carbapenems, and cephalosporins, have been associated with a wide range of neurologic manifestations such as epileptic seizures, encephalopathy, movement disorders, delirium, and psychosis, varying in onset, duration, severity, and reversibility. To induce such reactions, antibiotics interact with the central nervous system (CNS) in several ways that can threaten its integrity and disrupt homeostatic control of its components. This review provides a synopsis of the known neurological adverse reactions linked to four major antibiotic classes routinely used in UTI management and the mechanistic pathways underlying CNS toxicity. An overall clearer understanding of these risks may help clinicians balance therapeutic benefit against potential harm, optimize antimicrobial selection, and improve prevention and management strategies for antibiotic-associated neurotoxicity.

Fish swim bladder (FSB)-derived biomaterials have recently emerged as a promising marine-based extracellular matrix (ECM) platform with potential applications in urological tissue engineering and regenerative medicine. This narrative review synthesizes current evidence regarding the structural, biological, and functional properties of FSB and evaluates its potential role in urological reconstruction. This narrative review was conducted using the PubMed, Google Scholar, and ScienceDirect databases with predefined keywords related to FSB-derived biomaterials. Articles published from January 1, 2000, to December 31, 2025, were included. Eligible studies comprised original research, in vitro and in vivo experimental studies, and review articles. FSB is characterized by a high content of type I collagen, elastin, and glycosaminoglycans (GAGs), forming a well-organized, hydrated, and mechanically resilient matrix that closely resembles native mammalian ECM. These properties support cellular adhesion, proliferation, and tissue regeneration, while also modulating inflammatory responses during wound healing. Preclinical studies demonstrate that decellularized FSB scaffolds exhibit favorable mechanical properties, biocompatibility, and the ability to promote constructive tissue remodeling. In addition, hydrolyzed derivatives, such as gelatin and collagen peptides, have demonstrated antioxidant and regenerative properties. However, intrinsic antimicrobial activity remains limited, often requiring additional functionalization to achieve clinically relevant antibacterial effects. Safety considerations, including potential allergenicity, variability in raw materials, and the risk of microbial contamination, underscore the importance of standardized processing and rigorous sterilization protocols. Composition, thermal stability, and gelation behavior vary substantially across fish species, indicating that species selection is a critical determinant of scaffold performance. Despite encouraging findings in experimental models, clinical translation in urological applications remains limited. Further research focusing on organ-specific applications, long-term safety, and optimized scaffold design is essential. Overall, FSB-derived biomaterials represent a sustainable and versatile platform with significant potential to advance regenerative strategies in urological care.

Radium-223 and enzalutamide have shown survival benefits in metastatic castration-resistant prostate cancer, and recent trial data suggest a potential synergy in combination. However, real-world data on their combined use, especially regarding fracture risk and prior androgen receptor signaling inhibitor exposure, are limited. In this study, we aimed to evaluate the efficacy and safety of adding radium-223 to enzalutamide compared with enzalutamide alone in patients with bone metastatic castration-resistant prostate cancer. We retrospectively included patients treated with radium-223 plus enzalutamide (the combination group) or enzalutamide alone (the enzalutamide group), and compared progression-free survival, overall survival, prostate-specific antigen kinetics, alkaline phosphatase kinetics, and treatment-emergent adverse events. A total of 17 and 18 patients were included in the combination and enzalutamide groups, and the median age and follow-up duration were 75 years and 23 months, respectively. The median progression-free survival was significantly longer in the combination group (22 months [95% confidence interval (CI): 16.7-32.4]) than that in the enzalutamide group (5 months [95% CI: 6.3-25.2], p = 0.048). However, there was no significant difference in overall survival (combination: not reached [95% CI: 31.1-44.8] vs. enzalutamide: not reached [95% CI: 28.9-56.5], p = 0.602). In the combination group, there was no significant difference in progression-free and overall survival between patients with and without prior androgen receptor signaling inhibitor therapy. Fractures occurred in one (5.9%) and two (11.1%) patients in the combination and enzalutamide groups, respectively. In conclusion, the combination of radium-223 and enzalutamide did not improve overall survival in patients with metastatic castration-resistant prostate cancer. However, it significantly prolonged progression-free survival without increasing the risk of fractures when bone health agents were administered. Furthermore, prior exposure to androgen receptor signaling inhibitors was not associated with oncological outcomes of the combination therapy.

As ureteroscopy (URS) is increasingly utilized, preventing and managing severe postoperative infections-such as urosepsis-has become a clinical priority. Elevated intrarenal pressure (IRP) and irrigation fluid absorption (IFA) represent two core pathophysiological steps in the translocation of bacteria and endotoxins into the bloodstream. This review compares the clinical utility and technological maturity of IRP and IFA monitoring during URS. The analysis indicates that IRP is the instantaneous physical driving force for pyelovenous backflow, whereas IFA is the integrated outcome of multidimensional variables, including the pressure gradient, operative time and tissue permeability. Consequently, monitoring a single dimension may be insufficient to comprehensively assess infection risk. IRP monitoring (e.g., using a ureteral access sheath with a pressure-sensing channel or a flexible URS with an integrated pressure sensor) offers the advantage of real-time feedback, potentially playing a key role in maintaining low IRP and proactively preventing intrarenal backflow. However, it cannot account for the cumulative effect of time or changes in tissue permeability. IFA monitoring, despite its inherent lag, may provide a more comprehensive quantitative measure of the pathogenic load absorbed by the patient, suggesting potential predictive and warning value for the occurrence of infection; however, clinically validated thresholds and prospective evidence are currently lacking. In the future, with advancements in monitoring technology, the development of automated closed-loop systems integrating high-precision IRP monitoring, real-time IFA monitoring, intelligent irrigation and negative pressure suction holds promise for maximizing the balance between surgical efficacy and patient safety, provided that future studies can establish evidence-based intervention triggers.