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.

Botulinum toxin, once known only as the cause of botulism, has become a versatile therapeutic agent whose use in children now extends across many medical and surgical specialties. This narrative review synthesises the clinical use of botulinum toxin in patients up to eighteen years of age. We describe its pharmacology, the non-interchangeable commercial preparations, and the weight-based dosing and safety principles specific to childhood, then examine its applications by organ system. Gastrointestinal uses include functional constipation and internal anal sphincter achalasia, persistent obstruction after surgery for Hirschsprung disease, anal fissure, and achalasia. Urological uses centre on neurogenic and idiopathic detrusor overactivity and on sphincter-directed injection for dysfunctional voiding. Neurological uses are dominated by cerebral palsy spasticity and, on considerably weaker evidence, dystonia, while head and neck uses include sialorrhoea, congenital muscular torticollis, and strabismus. We also address neonatal brachial plexus palsy together with hyperhidrosis and aesthetic use in adolescents. The evidence supporting these uses is markedly uneven. Randomised controlled trials exist for only a small number of paediatric indications, chiefly spasticity in cerebral palsy, neurogenic detrusor overactivity, and chronic sialorrhoea, whereas most remaining applications rest on observational cohorts, small case series, or extrapolation from adult practice, and we grade the certainty of evidence separately for every indication. Only a few indications are formally approved, and most remain off-label, though increasingly supported. Botulinum toxin is a reversible and generally safe adjunct, but rigorous paediatric trials are still needed.

Bladder sensory neurons are essential components of lower urinary tract sensory encoding and micturition reflex control. They detect bladder filling, stretch, inflammatory mediators, and pathogen-associated stimuli, and they communicate with urothelial cells, immune cells, and stromal cells through neuropeptides such as calcitonin gene-related peptide (CGRP), substance P (SP), and vasoactive intestinal peptide (VIP). Under physiological conditions, this neuro-immune-urothelial axis contributes to bladder homeostasis. Under pathological conditions, including neural injury, infection, inflammation, or epithelial barrier disruption, TRP channels, purinergic signaling, neurotrophic factors, chemokines, and voltage-gated ion channels can induce peripheral sensitization, increased excitability of dorsal root ganglion (DRG) neurons, spinal plasticity, and central sensitization, thereby contributing to urinary frequency, urgency, bladder pain, and detrusor overactivity in neurogenic bladder and interstitial cystitis/bladder pain syndrome (IC/BPS). This review summarizes the anatomical and functional organization of bladder sensory afferents, sensory neuron-associated molecular signaling, neuro-immune-urothelial interactions, disease-specific mechanisms, and targeted therapeutic strategies. We also discuss the translational potential and limitations of interventions targeting TRPV1/TRPV4/TRPA1, P2X3, CGRP, SP/neurokinin receptors, NGF, ion channels, botulinum toxin, and neuromodulation. These mechanisms provide a framework for understanding neurogenic mechanisms in bladder disorders and for developing targeted interventions.

Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder in children. While lower urinary tract dysfunction (LUTD) is estimated to affect up to 33% of patients, it is frequently overlooked in clinical reports, and specific rehabilitation strategies are still lacking. We describe a pediatric patient with ADEM presenting with paraplegia and an areflexic neurogenic bladder, managed with a structured rehabilitation protocol, including clean intermittent catheterization, afferent neuromodulation, and pelvic floor training. Progressive neurological and urinary recovery was achieved within 2 months. This case highlights the potential role of early multidisciplinary rehabilitation in promoting bladder recovery in ADEM.

Transurethral incision of the bladder neck (TUI-BN) can effectively improve voiding efficiency in women with bladder neck obstruction. However, its role in women with low detrusor contractility remains unclear. This study retrospectively evaluated the clinical efficacy of TUI-BN and identified predictive factors for treatment failure in women with detrusor underactivity (DU).

This review summarizes the procedural techniques, short- and long-term efficacy, and clinical application of polyacrylamide hydrogel (PAHG, Bulkamid®) as a urethral bulking agent for female stress urinary incontinence (SUI); compares PAHG with mid-urethral sling (MUS) surgery; and examines emerging hydrogel-based regenerative platforms, used for mechanical bulking, delivery of bioactive molecules or cells, and extracellular matrix-mimetic scaffolding, together with their prospects for clinical translation.

Neurogenic lower urinary tract dysfunction (NLUTD) is frequently characterized by coexisting storage and voiding abnormalities, particularly in patients with spinal cord injury (SCI) and concomitant detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD). Conventional therapies often improve either storage or voiding function at the expense of the other, creating a significant therapeutic challenge. Combined intradetrusor and urethral botulinum neurotoxin type A (BoNT-A) injection has emerged as a potential dual-target strategy aimed at simultaneously improving bladder storage and facilitating bladder emptying. This review summarizes the current evidence regarding concomitant detrusor and urethral BoNT-A injection in patients with NLUTD. Available clinical data are limited and are derived predominantly from male patients with SCI, DO, and DSD. Preliminary studies have demonstrated improvements in urodynamic parameters, urinary continence, spontaneous voided volume, bladder compliance, and quality of life without significantly increasing clean intermittent catheterization frequency or post-void residual ratio. These findings suggest that combined injection may provide a therapeutic balance between storage and emptying functions while preserving spontaneous voiding. However, current evidence remains limited by small sample sizes, heterogeneous study designs, and the absence of randomized controlled trials. Important questions regarding optimal patient selection, long-term efficacy, and generalizability to other neurogenic conditions remain unanswered. Although future application in selected nonneurogenic patients may be possible, further prospective studies are required to establish the role of combined detrusor and urethral BoNT-A injection in the management of NLUTD.