Vesicovaginal fistula (VVF) is rare in children and is most commonly associated with retained vaginal foreign bodies. Surgical repair is technically demanding and carries a significant risk of recurrence, which has limited the application of minimally invasive approaches. We report the first pediatric case of robot-assisted laparoscopic transvesical repair of a VVF. A 14-year-old girl presented with longstanding urinary incontinence, malodorous vaginal discharge, and recurrent urinary tract infections, since early childhood. Initial imaging revealed a 30-mm bladder stone. Cystoscopy identified a large infratrigonal VVF associated with the stone, which had formed around a retained plastic ring. The foreign body and stone were removed through a suprapubic cystotomy. As spontaneous fistula closure did not occur after 1 year, definitive repair was undertaken. A robot-assisted laparoscopic transvesical approach was performed following cystoscopic identification of the ureteral orifices and placement of bilateral double-J stents. The fistula was closed in two watertight layers, with separate closure of the vaginal and bladder defects using absorbable sutures (Video 1). No intraoperative or postoperative complications occurred. The patient was discharged on postoperative day 2. At 1-year follow-up, she remained asymptomatic, with complete fistula closure, normal urinary continence, and normal uroflowmetry findings. Robot-assisted transvesical repair provides excellent visualization and precise suturing within the confined pelvic space, representing a promising minimally invasive option for the management of complex pediatric VVF.

Lower urinary tract symptoms that significantly impair quality of life in men may result from benign prostatic hyperplasia, overactive bladder, or a combination of both conditions. The diagnosis of benign prostatic hyperplasia, a voiding dysfunction due to outlet obstruction, can be made with a thorough history and physical examination. A validated questionnaire should be used to make an accurate initial diagnosis and to monitor treatment effect over time. Selective alpha-1 blockers are an appropriate first-line drug choice for most patients; however, 5-alpha reductase inhibitors and phosphodiesterase type 5 inhibitors may also be used, alone or in combination with each other, depending on symptom severity and if alternative treatment options are needed. If medical therapy is ineffective, surgical and interventional procedures aimed at opening the prostatic urethra are available to ameliorate symptoms. Overactive bladder manifests with urinary urgency, frequency, and nocturia with or without incontinence. The diagnosis of this storage dysfunction due to detrusor overactivity can be made with a thorough history, physical examination, urinalysis, and assessment of the residual volume of urine in the bladder after voiding. First-line treatment for overactive bladder includes beta-3 agonists as well as pelvic floor physical therapy and behavioral interventions. If left untreated, benign prostatic hyperplasia and overactive bladder can result in significant social isolation and relationship strain.

Male genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis that may lead to phimosis, urethral disease, sexual dysfunction and penile squamous cell carcinoma (PeSCC). Although its aetiology remains incompletely understood, clinical and epidemiological observations increasingly support a central role for chronic occluded exposure of susceptible epithelium to urine. The distribution of lesions to occluded, urine-exposed sites, the high rate of remission after circumcision, the rarity of disease in neonatally circumcised populations, the association with microincontinence and urological procedures, and the occurrence of lesions at urinary stoma sites all suggest an irritative pathogenesis. Secondary inflammatory, fibrotic and epithelial repair processes appear to arise downstream of this primary insult. Clinically, MGLSc presents with pallor, erythema, fissuring and progressive scarring, often accompanied by subtle urethral abnormalities contributing to post-micturition dribbling. Long-standing disease may result in meatal stenosis, urethral strictures and functional impairment. A well-recognised association exists between MGLSc, differentiated penile intraepithelial neoplasia and PeSCC, representing a carcinogenic pathway that is typically independent of human papillomavirus infection and ultraviolet radiation. Management aims to control inflammation, restore the epithelial barrier and reduce occlusion. Potent topical corticosteroids remain first-line therapy, while circumcision is highly effective when topical therapy fails. Additional medical and surgical treatments may be required in refractory or complicated disease. This review summarizes current knowledge on the clinical features, pathophysiology, malignant potential and management of MGLSc, with emphasis on mechanisms related to occlusion and urinary exposure.

Objective: To analyze the clinical characteristics of lower urinary tract dysfunction (LUTD) in school-age children, examine their correlation with emotional-behavioral problems, and explore the potential influencing factors for such problems in this population. Methods: This case-control study enrolled 130 LUTD patients aged 6-12 years who were admitted to Shanxi Children's Hospital from June 2024 to October 2025, comprising the LUTD group. A control group of 125 age- and gender-matched children undergoing routine health check-ups at the hospital's outpatient department during the same period was also established. All participants were assessed by using a general information questionnaire, the dysfunctional voiding and incontinence scoring system (DVISS) and the Achenbach Child Behavior Checklist (CBCL) to evaluate lower urinary tract symptoms and emotional-behavioral problems. Independent sample t test, Mann Whitney U or χ2 test were used for comparison between groups. Multiple linear regression was applied to analyze the risk factors for emotional and behavioral problems in the LUTD group. Spearman rank correlation analysis was used to examine the correlation between emotional and behavioral problems and DVISS scores in the LUTD group. Results: The LUTD group consisted of 72 males and 58 females, with age of (8.5±1.7) years, while the control group included 66 males and 59 females, with age of (8.9±1.7) years. The scores of the total CBCL score, depression, hyperactivity, aggression, boy social problems and schizoid traits were all higher in the LUTD group than in the control group (t=4.78, Z=2.71, 4.76, 3.60, 2.17, 2.10, all P<0.05). Multiple linear regression analysis revealed that low educational level of caregivers, poor academic performance, family conflict and abnormal DVISS score were associated with emotional and behavioral problems in children with LUTD (β=4.99, 5.85, 2.87, 5.75, all P<0.05). In the LUTD group, DVISS scores were all positively correlated with the scores of social withdrawal, hyperactivity, aggression, social problems, obsessive-compulsive symptoms and the total CBCL score (r=0.24, 0.22, 0.21, 0.27, 0.29, 0.51, all P<0.05). Conclusions: School-aged children with LUTD are more likely to develop emotional-behavioral problems than healthy children. These problems are associated with the educational level of caregivers, severity of lower urinary tract symptoms, academic performance, and family relationships.