Multiple system atrophy (MSA) is a progressive neurodegenerative synucleinopathy characterized by autonomic dysfunction, including significant genitourinary involvement that predisposes patients to urinary retention and infection. We present the case of an 81-year-old man with advanced MSA and chronic urinary retention who developed septic shock shortly after elective suprapubic catheter placement. His hospital course was complicated by emphysematous pyelitis, acute kidney injury, and hemodynamic instability requiring vasopressor support. This case highlights the increased risk of severe infectious complications following urologic instrumentation in patients with MSA and underscores the importance of anticipatory perioperative management in this high-risk population.

Aripiprazole (ARI), an atypical antipsychotic, has demonstrated anticancer activity in several malignancies and may be a candidate for drug repurposing as an intravesical therapy for bladder cancer, particularly non-muscle-invasive bladder cancer (NMIBC). This study evaluated whether brief, intravesical-like ARI exposure could induce cytotoxic effects in bladder cancer cells while preserving normal bladder structure and function. RT4 and T24 bladder cancer cells, together with non-malignant UROtsa urothelial cells, were exposed to ARI (1-300 μM) for 30 min or 2 h, and viability was assessed at 24, 48 and 72 h. Reactive oxygen species (ROS) generation was measured in RT4 and T24 cells after 2 h pretreatment, while caspase-3 activity and stress-associated protein expression were examined in T24 cells. In parallel, an ex vivo porcine bladder model was used to assess the effects of luminal ARI pretreatment (300 μM, 2 h) on urothelial thickness, ATP and acetylcholine release, detrusor contractility, β-adrenergic relaxation, and nerve-evoked responses. ARI reduced viability in a concentration-dependent manner in RT4, T24 and UROtsa cells, with greater cytotoxicity after 2 h pretreatment. In bladder cancer cells, ROS increased only at higher concentrations, whereas ARI increased caspase-3 activity at lower concentrations and altered multiple stress-related proteins in T24 cells. In porcine bladder, ARI preserved urothelial structure and mediator release, maintained detrusor and neurogenic function, and enhanced the inhibitory influence attributed to urothelium-derived inhibitory factor (UDIF). Collectively, these findings identify ARI as a mechanistically active yet bladder-sparing candidate for intravesical repurposing and support its further evaluation as a potential therapy for bladder cancer.