Prior to the first human bladder transplant (NCT#06337942), a standardized method for vascularized composite bladder allograft (VCBA) recovery compatible with routine donation-after-brain-death (DBD) multi-organ recovery workflow was necessary. A reproducible open surgical technique for VCBA recovery was developed and implemented and is described herein. Under an IRB-approved protocol (IRB#4B-21-5), open VCBA recoveries were performed on 10 DBD donors during standard multi-organ recovery. The primary objective was to develop and refine a reproducible technique to recover the bladder maintaining arterial, venous, and pelvic vascular structures needed for transplantation, without disrupting conventional abdominal organ recovery. Operative sequencing, organ recovery team coordination, graft perfusion, and technical feasibility metrics were evaluated. Median donor age was 35.5 years, with equal distribution between male and female donors. Mean operative times for VCBA recovery and back-table reconstruction were 93 and 35 minutes, respectively. Hypothermic continuous bladder irrigation preceded aortic cross-clamping. Pelvic organ perfusion and successful preservation of bilateral internal iliac vascular pedicles were achieved in all cases. All grafts demonstrated appropriate tissue blanching. Bilateral splanchnic nerves were preserved in the final four recoveries. This open approach enabled expeditious VCBA retrieval without disrupting standard multi-organ recovery, establishing a practical, scalable strategy for clinical VCBA transplantation. Clinical Trial and IRB Reference Numbers: NCT#05462561, NCT#06337942, IRB#4B-21-5.

Catheter-associated urinary tract infections (CAUTIs) remain among the most frequent healthcare-associated infections. Increasing antimicrobial resistance has renewed interest in bladder irrigation as a non-antibiotic therapeutic strategy. Tap water and povidone-iodine are two readily available irrigation solutions that have recently been evaluated in prospective clinical studies. A comparative narrative review was undertaken using two prospective clinical investigations published in peer-reviewed journals to compare the clinical effectiveness, safety, tolerability, and potential role of tap-water and povidone-iodine bladder irrigation in patients with recurrent CAUTIs. Study characteristics, patient demographics, intervention protocols, outcome measures, microbiological findings, safety outcomes, quality-of-life measures, and clinical applicability were compared qualitatively. Both bladder irrigation strategies appear clinically beneficial. Povidone-iodine demonstrated greater reductions in infection-related outcomes but involved daily antiseptic instillation in a narrowly defined neurogenic bladder population. Tap-water irrigation produced moderate reductions in antibiotic use and recurrent urinary tract infections while maintaining excellent patient acceptability and quality of life, suggesting an attractive low-cost strategy suitable for wider implementation. Direct comparative randomized trials are required.

Background and Clinical Significance: Malignant priapism is a rare manifestation of advanced malignancy caused by malignant infiltration of the corpora cavernosa. We report a case of persistent and refractory priapism associated with penile carcinoma and extensive metastatic disease, with a suspected pulmonary primary. Case Presentation: An 81-year-old man with a history of prostate cancer treated by radical prostatectomy and persistently undetectable PSA levels developed persistent low-flow priapism. Despite aspiration and irrigation, followed by distal and proximal shunting procedures, the condition recurred with progressive corporal induration and severe pain. Cavernous biopsy was initially interpreted as moderately differentiated squamous carcinoma, while total penectomy performed for refractory pain showed poorly differentiated carcinoma with morphological adenosquamous features. CT and PET/CT demonstrated a pulmonary mass and widespread metastatic disease, although bronchoscopy was non-diagnostic and no histological confirmation of the pulmonary lesion was obtained. A focused review of the literature identified 32 published cases of malignant priapism; bladder cancer was the most frequently reported primary malignancy (37.5%), followed by prostate cancer (18.8%) and renal cell carcinoma (9.4%), while penectomy was performed in 34.4% of cases. Conclusions: Persistent or recurrent priapism associated with corporal induration, progressive or atypical pain, failure of conventional treatment, or discordant imaging findings should raise suspicion of malignant infiltration and prompt consideration of repeat imaging and tissue sampling. In the present case, carcinoma involving the penile structures was histologically confirmed, whereas pulmonary origin remained a clinicoradiological suspicion; penectomy provided immediate pain relief in the setting of extensive refractory local disease.

Emphysematous cystitis (EC) is a rare, complicated urinary tract infection characterized by gas formation in and around the bladder wall, often occurring in older adults with diabetes mellitus, urinary tract obstruction, or long-term indwelling urinary catheters. EC can be easily misdiagnosed due to atypical symptoms and signs. Delayed treatment causes life-threatening complications like emphysematous pyelonephritis, bladder perforation, or septic shock. Here, we retrospectively analyzed two cases of EC who had been effectively treated and discharged following antibiotics, strict blood sugar control, bladder irrigation, and symptomatic and supportive treatment. Through literature review, we summarized the clinical characteristics, diagnostic skills, and therapeutic strategies for EC. Our experience may inform the early diagnosis and standardized management to improve the prognosis of EC.

To investigate the efficacy and safety of a modified transurethral diode laser four-troughs vaporesection in treating benign prostatic hyperplasia (BPH). The clinical data of BPH patients who underwent prostatic surgery between January 2023 and June 2025 at Guangdong Provincial People's Hospital, Southern Medical University were retrospectively included. The patients were divided into two groups according to the surgical methods: the four-troughs group (patients who underwent modified four-troughs vaporesection of the prostate using a 1 470 nm diode laser), and the enucleation group (patients who underwent 1 470 nm diode laser enucleation of the prostate). The patients were followed up to 6 months after surgery. Independent sample t test, Mann-Whitney U test and analysis of covariance were used to compare perioperative related indicators between the two groups, including prostate volume, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), duration of surgery, hemoglobin drop level, length of hospital stay, bladder irrigation time and postoperative complications. A total of 103 male patients, aged of (70±6) years, were included. Fifty-five patients were included in the four-troughs group and 48 patients in the enucleation group. The follow-up duration [M (Q1, Q3)] was 3 (2, 5) months. The operative time [(109±36) vs (124±35) min, P=0.024] and hospital stay [(9.4±3.6) vs (11.5±3.4) days, P=0.010], hemoglobin drop level [(6.6±7.8) vs (11.7±8.3) g/L, P=0.002] of the four-troughs group were lower than those of the enucleation group. There were no statistically significant differences in prostate volume, Qmax, PVR, preoperative or postoperative IPSS and QoL between the two groups. (all P>0.05). A total of 5 patients developed mild postoperative complications (2 in the four-troughs group and 3 in the enucleation group), and all improved after symptomatic treatment. The modified transurethral 1 470 nm diode laser four-troughs vaporesection is easy to operate, which is associated with less reduction in hemoglobin level and a shorter operative time. Its short-term therapeutic efficacy and safety are comparable to those of enucleation.

Stone retropulsion during ureteroscopy (URS) remains a significant challenge that can prolong operative time and may require additional procedures. Antegrade irrigation through a percutaneous nephrostomy (PCN) tube has been described primarily for proximal ureteral stones. We report the successful application of this technique in a patient with bilateral distal ureteral stones using pre-existing bilateral PCN tubes during rigid ureteroscopic laser lithotripsy. A 50-year-old woman presented with bilateral flank pain, dysuria, hematuria, and fever. Laboratory findings showed elevated creatinine levels and leukocytosis. Non-contrast CT revealed multiple bilateral distal ureteral stones, the largest measuring 12.4 mm, with moderate-to-severe hydroureteronephrosis and left lower calyceal stones. Bilateral PCN tubes were inserted, resulting in clinical and biochemical improvement. Two weeks later, elective bilateral rigid URS with laser lithotripsy was performed under continuous gravity-assisted antegrade saline irrigation through the PCN tubes. The antegrade flow promoted the distal migration of stone fragments, minimized proximal retropulsion, and maintained a clear visual field. All fragments were successfully retrieved using a Dormia basket, and bilateral double-J stents were placed. At four weeks, a postoperative kidney-ureter-bladder (KUB) radiograph showed no visible residual radiopaque stones. No irrigation-related complications were observed. In conclusion, antegrade irrigation through PCN tubes may be a practical, low-cost adjunct that facilitates fragment management and may improve stone-free outcomes, even for distal ureteral stones, particularly in patients requiring initial urinary diversion. This technique warrants further evaluation in larger studies.

Severe dilutional hyponatraemia is a recognised complication of transurethral resection of the prostate (TURP syndrome) caused by systemic absorption of hypotonic irrigation fluid, but similar events outside the operative setting are rarely reported. We describe a 77-year-old White male with radiation cystitis who underwent 12 days of sterile water bladder washouts alongside continuous 0.9% saline bladder irrigation for persistent haematuria. Serum sodium declined from 132 to 112 mmol/L and improved only after bladder washouts and irrigation were discontinued. Cystoscopy confirmed radiation cystitis with mucosal ulceration. The clinical course strongly suggests that systemic absorption of electrolyte-free sterile water caused the profound hypotonic hyponatraemia, whereas concurrent absorption of isotonic saline contributed to extracellular volume expansion. This case highlights that prolonged sterile water bladder washouts may produce a TURP-like syndrome in the absence of surgery. Early recognition, serial electrolyte monitoring and prompt source control are essential to prevent potentially life-threatening complications.