We report a case of bladder pain syndrome (BPS) in which pain improved with clean intermittent catheterization (CIC). The patient wasa 26-year-old woman who had experienced urinary frequency since childhood. Two years prior to visiting our hospital, her symptoms worsened, leading her to seek medical attention for increased frequency and bladder pain. Cystoscopy revealed no Hunner's lesions, but a voiding diary indicated reduced bladder capacity. A trial of bladder hydrodistension was performed without symptomatic improvement. She was referred to our department for further evaluation and management. Pressure-flow study (PFS) showed reduced detrusor contractility with significant abdominal straining during voiding. Although there was no post-void residual, she experienced severe voiding pain, prompting initiation of CIC. While her symptoms improved, attempts to discontinue CIC resulted in pain recurrence, and she continued CIC for over two years. This case highlights the diagnostic value of PFS and the potential effectiveness of CIC in selected BPS patients.

Urethral stricture is a fibrotic narrowing of the urethra leading to significant lower urinary tract obstruction, predominantly affecting men. Its etiology is multifactorial, with iatrogenic causes being most common in industrialized countries. Pathophysiologically, inflammatory or traumatic processes result in spongiofibrosis and subsequent luminal narrowing. Clinically, patients present with obstructive voiding symptoms, urinary retention, and potential complications such as infections or renal impairment. Diagnosis relies on patient history, physical examination, uroflowmetry, and imaging, with retrograde urethrography considered the gold standard. Treatment options include endourological and open reconstructive approaches. Minimally invasive techniques such as dilation and internal urethrotomy are suitable for short strictures but are associated with high recurrence rates. Open urethroplasty remains the gold standard for long or recurrent strictures, achieving long-term success rates of up to 95%. Reconstructive techniques include end-to-end anastomosis and substitution urethroplasty using autologous oral mucosa grafts. Emerging tissue-engineered grafts show promising outcomes. Structured follow-up is essential for early detection of recurrence and long-term treatment success.

A series of adult male (n = 6) and female (n = 4) rhesus macaques (Macaca mulatta) underwent a bilateral S1 ventral root avulsion injury for longitudinal lower urinary tract studies in a motor-sparing experimental model of conus medullaris syndrome. The surgeries were well tolerated, and all animals recovered well postoperatively. However, one male animal presented clinically with acute lethargy, poor appetite, and unwillingness to move at 51 days after the bilateral S1 ventral root avulsion injury. Physical examination under sedation detected an enlarged bladder, which was emptied via transurethral bladder catheterization. When the animal re-presented for similar symptoms over the following 2 days, radiographic and ultrasound studies revealed cystolithiasis with urethral obstruction. Repeat transurethral bladder catheterizations reestablished functional patency of the urethra, independent voiding, and full clinical recovery. Two weeks later, the animal presented again with acute lethargy, poor appetite, unwillingness to move, and an enlarged bladder. Cystolithiasis and the recurrence of urethral obstruction were diagnosed by radiographic and sonographic studies. Subsequent transurethral bladder catheterization was unable to dislodge the obstruction, and the animal was euthanized. Necropsy identified 3 bladder stones. Histochemistry of the bladder and urethral walls showed some acute inflammation but absence of chronic changes. Chemical analysis of bladder stone composition showed calcium phosphate (90%) and calcium carbonate (10%). Our case highlights the value of an expedited physical examination and noninvasive imaging to diagnose cystolithiasis complicated by an acute urethral obstruction, a medical emergency, in a rhesus macaque presenting with nonlocalizing symptoms. Although spinal cord injury is an established risk factor for urolithiasis in humans, our case provides the first (to our knowledge) association of a spinal cord injury syndrome with cystolithiasis in a nonhuman primate.

Background and Clinical Significance: Posterior urethral valves are rare congenital anomalies characterized by persistent urethral mucosal folds and causing varying degrees of obstruction. The increasing use of prenatal ultrasound has contributed to the early diagnosis of posterior urethral valves (PUV), a condition associated with a severe prognosis, as approximately one-fifth of affected patients develop chronic kidney disease. Early diagnosis and intervention-namely, valve ablation-provide obstruction alleviation and renal function preservation. Therefore, it is uncommon for patients to be diagnosed in adolescence or adulthood, when patients usually present with frequency, voiding dysfunction, daytime incontinence, enuresis, recurrent urinary tract infections, and renal insufficiency. Case Presentation: We present a 14-year-old adolescent with recurrent urinary tract infections. A thorough medical history, clinical examination, and standard imaging revealed bilateral vesicoureteral reflux and posterior urethral valves. The patient underwent urethrocystoscopy for diagnostic and therapeutic purposes and posterior urethral valve ablation. Despite these interventions, the persistence of his symptoms necessitated endoscopic correction of the vesicoureteral reflux and circumcision. During the 2-year follow-up, the patient remained asymptomatic. Conclusions: Symptomatic adolescent boys should undergo a standard urinary evaluation to identify undiagnosed congenital urinary tract diseases and maintain renal and bladder function.

Posterior urethral valve (PUV) rarely causes adult lower urinary tract obstruction and is rarely linked to posterior urethral calculi. A 21-year-old male with 5-year history of (LUTS) had a 19 × 22 × 39 mm posterior urethral stone removed via open cystolithotomy (35 mm stone). Persistent poor flow led to RUG/MCUG showing urethral dilatation and cystoscopy confirming PUV, ablated with holmium laser. Post-ablation uroflowmetry improved markedly. Adult PUV with impacted calculus is extremely rare, mimicking isolated stone disease. High suspicion for PUV in young males with posterior calculi and post-removal LUTS is vital; cystoscopy and voiding studies ensure accurate diagnosis and management.