Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-associated infections in the United States, accounting for >1 million cases annually. One CAUTI pathogen, Staphylococcus aureus, is commonly found persisting asymptomatically in the bladder of catheterized individuals, increasing these individuals' risk of developing infection. Importantly, S. aureus is not only associated with severe symptoms during CAUTI, including bacteremia and septic shock, but it also produces a common uropathogen-associated virulence factor, urease. Despite its importance, urease has only been well-studied in another uropathogen, Proteus mirabilis. While previous studies identified three S. aureus urease regulators, including CodY, CcpA, and Agr, the environmental signals required for expression and activity, and the enzyme's contribution to CAUTI have not been explored. In this study, we demonstrate that post-exponential growth and growth in the urinary tract environment significantly induce S. aureus urease expression and activity. Additionally, we identify SigB, SaeR, and SrrA as novel regulators of urease, and further explore the role of CodY, CcpA, and Agr-previously implicated in urease expression-in urease regulation in the urinary tract environment. Impactfully, we found that the urease promoters of clinical isolates contain genomic changes that enhance urease expression. Furthermore, urease contributes to biofilm formation under catheterized urinary tract-like conditions in vitro and dissemination from the bladder to the kidneys in a mouse CAUTI model. Together, our data not only provide insight into the regulatory pathway controlling S. aureus urease but also emphasize the importance of studying these mechanisms in a model that mimics the urinary environment.

We report the first case of penile sensory reconstruction in a patient with spina bifida in Japan. A 27-year-old man presented with congenital sensory loss in the perineal region owing to spina bifida. His myelomeningocele was repaired immediately after birth. He was unable to recognize bladder fullness and required urinary self-catheterization. Emotional erection and ejaculation were possible, and his gait was normal. We elected to perform the TOMAX procedure (i.e., TO MAXimize sensation, sexuality, and quality of life) to reconstruct penile sensation. Microsurgical sensory nerve anastomosis between the ilioinguinal nerve and the dorsal nerve of the penis was performed bilaterally under general anesthesia. No complications occurred. Penile sensation was noted 3 months after surgery. At the 1-year follow-up, the patient could detect the blue filament on Semmes-Weinstein testing. The TOMAX procedure can provide sensory recovery in patients with spina bifida and improve their quality of life.

Squamous cell carcinoma (SCC) of the bladder is a rare subtype accounting for 2-5% of bladder cancers in Western countries. Its epidemiology, biological drivers, and clinical behavior differ substantially from urothelial carcinoma (UC), yet most management strategies remain extrapolated from UC due to the absence of dedicated evidence. Robust data are limited, and therapeutic decision-making is challenged by the rarity of this aggressive variant. Bladder SCC is strongly associated with chronic inflammatory conditions, including schistosomiasis, long-term catheterization, and recurrent urinary infections. Most patients present with muscle-invasive disease, characterized by marked local aggressiveness and a lower incidence of early nodal or distant metastases compared with UC. Molecular profiling indicates a predominant basal/squamous phenotype with frequent EGFR pathway activation and TP53/RB1 alterations, highlighting potential therapeutic vulnerabilities. However, the efficacy of perioperative chemotherapy, immunotherapy, or antibody-drug conjugates remains uncertain, as SCC patients are consistently underrepresented in clinical trials and outcomes are rarely reported separately. Emerging targeted strategies, such as Nectin-4 and Trop-2-directed agents, show promise but require prospective, SCC-specific evaluation. Bladder SCC remains an orphan malignancy with significant unmet clinical needs. Dedicated multicenter efforts are crucial to refine diagnostic pathways, integrate molecular characterization, and develop tailored therapeutic approaches. The French AVENTUR Group aims to address these gaps by coordinating national collaboration across institutions and promoting prospective clinical and translational research to improve outcomes in this rare and aggressive bladder cancer subtype.

Ketamine misuse is increasingly implicated in significant urological morbidity, most notably ulcerative cystitis and progressive bladder fibrosis. Rhabdomyolysis represents a less frequently recognised complication but carries the potential for life-threatening electrolyte derangement and acute kidney injury (AKI). We report a man in his mid-20s with heavy recreational ketamine use presenting after collapse with severe hyperkalaemia (8.2 mmol/L), marked rhabdomyolysis (peak creatine kinase ~40,000 IU/L), and stage 3 AKI requiring continuous venovenous haemodiafiltration (CVVHDF). Clinical management was further complicated by ketamine-associated bladder dysfunction, which precluded urethral catheterisation. This case study gives an overview of a patient who presented with a number of unusual features: severe ketamine-associated rhabdomyolysis, dialysis-requiring AKI, and complex electrolyte management on a background of established uropathy. We propose that renal failure was principally attributable to myoglobin-mediated acute tubular injury arising from rhabdomyolysis, potentiated by dehydration, prolonged immobilisation, sympathetic overactivity, and impaired urinary clearance.

Catheter-associated urinary tract infections (CAUTIs) remain a major contributor to healthcare-associated infections and antimicrobial resistance, compounded by diagnostic uncertainty that drives overtreatment of asymptomatic bacteriuria. Current passive prevention strategies have reached a plateau, leaving patients requiring prolonged catheterisation vulnerable to early biofilm formation. Historical irrigation approaches have largely failed because they target mature biofilms rather than the early formation phase (days 1-5). These approaches rely on manual techniques prone to contamination, poor standardisation, and high operational burden. Automated bladder irrigation is proposed to address these limitations through programmable early-phase intervention, closed-system sterility, and reduced dependence on healthcare worker handling. As a non-antibiotic approach, it may support infection prevention and antimicrobial stewardship by reducing CAUTI incidence and minimising diagnostic ambiguity that leads to inappropriate antimicrobial use. Therefore, effective CAUTI prevention requires a shift from passive catheter stewardship to active, biofilm-informed bladder management that addresses both infection control and antimicrobial resistance.