Background: Giant retroperitoneal schwannomas with vertebral body erosion are exceedingly rare, and the decision regarding spinal instrumentation following tumor resection remains controversial in the absence of established guidelines. A 25% vertebral body involvement threshold has been proposed as an indication for fixation, yet this criterion does not account for bone quality or the potential biological adaptation of bone to chronic mechanical loading. Case Presentation: A 56-year-old man presented with bilateral gluteal pain and urinary urgency secondary to a giant retroperitoneal lumbar schwannoma (97 × 67 mm) with 36.6% erosion of the L5 vertebral body, confirmed by CT-guided biopsy (S100+, SOX10+, Ki-67 < 5%). Despite erosion exceeding the proposed instrumentation threshold, complete tumor resection was performed via an anterior laparotomic approach without spinal fixation, based on the absence of clinical or radiological signs of instability and the integrity of the intervertebral disc and posterior ligamentous complex. Intraoperative neurophysiological monitoring guided sacrifice of the tumor-origin root. The postoperative course was uneventful, with complete resolution of symptoms and no new complaints or neurological deficits at one-year follow-up. Conclusions: Post-hoc Hounsfield Unit measurements on pre-operative CT demonstrated markedly elevated bone density at the eroded L5 vertebral body (480 HU) compared with the adjacent L4 vertebra (317 HU), consistent with compensatory sclerosis induced by chronic mechanical compression. Pre-operative HU assessment may represent a valuable, readily available adjunct to anatomical erosion criteria in the surgical decision-making process for giant schwannomas with vertebral body involvement.

The diagnosis of acute community-acquired bacterial urinary tract infections (UTIs) in adult men presently recognizes four key clinical entities: cystitis, prostatitis, pyelonephritis, and epididymo-orchitis, each with distinct diagnostic criteria. Bacteriuria of clinically undetermined significance, defined as documented bacteriuria with non-specific systemic symptoms (e.g., confusion, functional decline, or isolated fever) but no localized UTI signs, is common in elderly patients and requires evaluation with sepsis risk scores so as to avoid unnecessary antibiotics. Urinary colonization, frequent in older men, does not warrant treatment unless prior to urological procedures. Cystitis is diagnosed by local symptoms (dysuria, urgency, suprapubic pain), absence of fever, and positive urine culture, ruling out prostatitis or pyelonephritis. Acute prostatitis is identified by cystitis symptoms plus fever or sepsis, with imaging reserved for complications. Acute pyelonephritis is diagnosed by fever or sepsis, flank pain (spontaneous or on percussion), and positive urine culture; cystitis symptoms may be absent. Urine culture (thresholds: ≥10[3] CFU/mL for bacteriuria, leukocyturia >30 × 10[3]/mL) remains the gold standard, while urine dipstick testing is not recommended due to low predictive value. Routine blood tests (inflammatory markers, PSA, or blood cultures) are unnecessary in outpatient management, even for febrile UTIs, unless acute kidney injury or complications are suspected. Pyelonephritis requires imaging (urgent in cases of sepsis or obstruction) to assess for uropathy, and epididymo-orchitis mandates STI screening.

Immune checkpoint inhibitors (ICIs) have beneficially impacted cancer therapy but are frequently associated with immune-related adverse events (irAEs), most commonly affecting the skin and gastrointestinal system. By contrast, genitourinary toxicities are rare and often underrecognized. The present case report outlines a 62-year-old male with metastatic colorectal cancer who developed pan-urinary tract irAEs (concurrent immune-related nephritis, ureteritis and cystitis) after exposure to three distinct classes of ICIs. The patient initially experienced pollakiuria, urinary urgency, dysuria and hematuria, which worsened after switching to cadonilimab and adebrelimab. This deterioration coincided with rising serum creatinine levels and lack of improvement with antibacterial treatment. Urinalysis revealed leukocyturia and hematuria, while imaging demonstrated bilateral hydroureteronephrosis and diffuse bladder wall thickening. A multidisciplinary evaluation led to the diagnosis of ICI-induced pan-urinary tract irAEs. Both urinary symptoms and renal function resolved rapidly after halting immunotherapy and starting glucocorticoid treatment, with no recurrence during follow-up. In addition, a comprehensive review of reported cases was conducted to characterize this rare irAE presentation and further propose both diagnostic criteria and management strategies to facilitate early detection and effective treatment.

Psychological distress is a major public health issue with multisystemic effects, yet its multidimensional nature and specific links to urogenital disorders remain inadequately characterized due to methodological limitations of prior studies. This large-scale study utilized data from the UK Biobank (N = 501,988) to investigate both cross-sectional and prospective associations between six validated psychometric instruments including emotional distress (MHS-20), neuroticism (N-12), somatic symptoms (RDS-4), depression (PHQ-9), and anxiety (GAD-7) and eight non-infectious urogenital conditions. Multivariable-adjusted logistic and Cox proportional hazards models were employed, controlling for demographic, socioeconomic, lifestyle, and clinical confounders. Multiplicative interaction analyses were introduced to evaluate effect modification by age, sex, and menopausal status. Higher scores across all psychological scales were associated with increased incidence of urogenital diseases, with the strongest associations observed for RDS-4 with urgency urinary incontinence (HR = 1.48, 95% CI: 1.39-1.58), IC/BPS (HR = 1.49, 95% CI: 1.25-1.78), and pelvic pain (HR = 1.49, 95% CI: 1.35-1.64). Interaction analyses indicated significant effect modifications by age, sex, and menopausal status for specific bladder and pelvic floor disorders. For sex-specific patterns, females exhibited stronger associations for IC/BPS and other bladder disorders, whereas pelvic floor dysfunction showed stronger associations in males. Associations for pelvic myalgia remained consistent across sexes, indicating no significant effect modification. Chronic prostatitis showed limited to no prospective associations with psychological distress. Multidimensional psychological distress represents a risk factor for urogenital disorders, with notable demographic variations. These findings support the incorporation of structured psychological assessments into urological practice to facilitate a more integrated, biopsychosocial approach to patient management.

Following a first male urinary tract infection (mUTI), systematic investigation for predisposing factors is called for, as mUTIs frequently arise secondarily to anatomical or functional urinary tract abnormalities. Although no international consensus defines a minimal etiological work-up, guidelines from the French (AFU) and European (EAU) Associations of Urology provide a clinical framework. First-line assessment comprises a targeted history (laying emphasis on macroscopic hematuria and lower urinary tract symptoms, LUTS), digital rectal examination (DRE), the International Prostate Symptom Score (IPSS), and urinary tract ultrasonography with post-void residual (PVR) measurement. LUTS, classified as storage (urgency, frequency), voiding (weak stream, straining), or post-micturition (incomplete emptying) may indicate benign prostatic hyperplasia (BPH), the leading aetiology in men over 50. Ultrasound evaluates prostate volume, bladder morphology, and PVR; voiding diaries complement assessment when storage LUTS predominate. Alpha-blockers represent first-line therapy for BPH-related LUTS. Routine PSA testing following mUTI is not recommended, as elevations are non-specific: prostatitis may raise PSA independently of malignancy, and levels can remain elevated up to three months post-infection. No association exists between a first mUTI and prostate cancer, nor between PSA and UTI recurrence. Second-line referral is indicated for pyelonephritis, urinary retention, macroscopic hematuria, IPSS >7, PVR >100 mL, recurrent UTI, age under 40, or imaging abnormalities. Cross-sectional imaging (CT or MRI) is reserved for suspected obstruction, severe presentations, or treatment failure. This stratified approach optimizes cost-effectiveness, ensuring identification of underlying pathology (BPH, urolithiasis, or malignancy) while avoiding unnecessary investigations.

Posterior urethral valves (PUV) are rare congenital malformations affecting both the upper and lower urinary tract and can lead to severe long-term complications. Thanks to advances in prenatal diagnostics, neonatal care, and pediatric urological-nephrological management, an increasing number of patients now reach adulthood. Long-term outcomes are primarily determined by the extent of prenatal renal dysplasia as well as the early recognition and targeted management of bladder dysfunction. Care of adult PUV patients remains challenging, as many adult urologists have limited experience and evidence-based guidelines for long-term management are lacking. Adult PUV patients constitute a clearly defined high-risk cohort with characteristic urological and renal sequelae, including persistent or secondary progressive bladder dysfunction with clinically significant lower urinary tract symptoms (LUTS) and an increased risk of progressive chronic kidney disease (CKD) up to end-stage renal disease (ESRD). In cases of ESRD, kidney transplantation may be required; optimized bladder function is crucial to preserve graft function, and reconstructive procedures, such as bladder augmentation, may be necessary.Bladder function evolves throughout life: initially hypertrophic and hyperactive, it may later decompensate, leading to hypocontractility or atony ("myogenic failure"). Adult patients often report voiding difficulties, post-void residual urine, urgency, incontinence, and recurrent urinary tract infections, which can significantly impair quality of life, self-esteem, and sexual self-efficacy. Treatment is guided by the individual urodynamic phenotype and may include conservative, pharmacological, and, when necessary, interventional strategies.Sexual function and fertility are preserved in most patients; limitations primarily occur in advanced CKD or complex bladder management scenarios. Psychosocial burdens related to altered body image, incontinence, catheterization, or concerns regarding partnership and family planning are common and should be addressed early. Optimal care for PUV patients requires lifelong, interdisciplinary follow-up, structured transition from pediatric to adult care, and close coordination between urology, nephrology, pediatric urology/nephrology, and transplant medicine to ensure long-term preservation of renal function, quality of life, and graft survival.

Introduction Persistent lower urinary tract symptoms (LUTS) in young adults following childhood primary nocturnal enuresis (PNE) refractory to desmopressin represent an undercharacterized condition at the pediatric-adult care interface. No prior study has compared pharmacotherapy options in this specific population. Methods We performed a retrospective, single-center, hypothesis-generating comparative cohort study at a tertiary urology center (January 2017-September 2025). Male adults aged 18-35 years with documented childhood primary nocturnal enuresis (PNE) based on International Children's Continence Society (ICCS) criteria, desmopressin treatment failure, and persistent storage-phase lower urinary tract symptoms (LUTS) were included. Patients received mirabegron 25-50 mg daily (Group A, n=33) or anticholinergic therapy (Group B, n=32). The primary outcome was categorical treatment response (complete ≥75%, partial 50-74%, minimal 25-49%, failure <25%). Secondary outcomes included nocturia, urgency, micturition frequency, incontinence episodes, International Prostate Symptom Score (IPSS), quality of life, and adverse events. Analyses used independent t-tests, chi-square/Fisher exact tests, paired t-tests, and analysis of covariance (ANCOVA). Results Baseline characteristics were comparable between groups. Childhood nonmonosymptomatic enuresis (NMSE) phenotype was prevalent in 86.2% of patients, with reduced functional bladder capacity documented in 86.2%. Mirabegron achieved higher overall clinical benefit (≥50% improvement) than anticholinergics (78.8% vs. 56.3%, p=0.042) and higher complete response rates (24.2% vs. 6.3%, p=0.044). Symptom reductions consistently favored mirabegron: nocturia 51% vs. 38% (p=0.031), urgency 48% vs. 36% (p=0.024), micturition frequency 37% vs. 26% (p=0.018), and quality of life improvement 58% vs. 38% (p=0.009). Safety profiles were comparable with no serious adverse events and similar treatment persistence (90.9% vs. 87.5%, p=0.642). Conclusion Pending prospective confirmation, mirabegron provides superior efficacy with comparable safety versus anticholinergic therapy in male adults with persistent LUTS after desmopressin-refractory childhood PNE, supporting β3-adrenergic agonist therapy as a promising option for this underserved transitional population.

A 51-year-old female patient was diagnosed with neurofibromatosis type 1 (NF1) in 2000 (21 years ago). In 2015 (6 years ago), she underwent surgical resection of a mass in her right upper limb. The tumor was pathologically confirmed as malignant peripheral nerve sheath tumor (MPNST) (considering malignant transformation of neurofibroma) and neurofibroma. In 2021, she was admitted to the hospital due to urinary urgency and abdominal mass. Transvaginal ultrasound showed multiple masses in the uterus, and leiomyoma was considered. Multiple fish-like bleeding masses on the surface of the uterus, sigmoid colon and jejunum were found during the operation, and then combined gynecological and gastrointestinal surgery was performed. Postoperative pathology and immunohistochemistry (CD117, DOG-1, CD34 positive) confirmed that all masses were gastrointestinal stromal tumors (GIST)(including uterine Extra-GIST (EGIST)), and C-kit/PDGFRA gene mutation was negative. After 4 years of follow-up, there was no recurrence or metastasis of GIST and EGIST. The patient underwent 4 operations for neurofibroma in the back (including 1 reoperation for recurrence). We report a rare case of NF1 with concurrent right upper limb MPNST, jejunal GIST, and multiple EGISTs in the uterus and sigmoid colon. Despite overlapping pathological features, uterine and gastrointestinal stromal tumors differ clinically. Surgery is the primary treatment; comprehensive preoperative imaging and postoperative pathological examination are critical to prevent misdiagnosis and optimize management.

Interstitial cystitis (IC) and bladder pain syndrome (BPS) have several clinical phenotypes. However, these subtypes may have similar symptoms, such as bladder pain, frequency, urgency, and functional somatic syndrome. A global consensus has been reached that bladders with characteristic Hunner's ulcer lesions are classified as IC, whereas those without Hunner's ulcer are classified as non-ulcer IC/BPS. To diagnose Hunner's IC, office cystoscopy without anesthesia is usually adequate for visualizing the presence of Hunner's lesions. However, the diagnostic accuracy of cystoscopic hydrodistention for non-ulcer IC/BPS has not been validated. Cystoscopic hydrodistention can detect mucosal dysfunction and chronic inflammation over long periods. Different grades of glomerulation may develop after hydrodistention of the bladder to a pressure of 80 cmH2O, and the maximal bladder capacity under anesthesia can be measured. The cystoscopic characteristics of IC/BPS after hydrodistention are associated with bladder symptoms, bladder wall CT findings, inflammatory urine biomarkers, and histopathological findings in the bladder wall. Cystoscopic hydrodistention can be a useful diagnostic examination and a treatment for IC/BPS. Cystoscopic findings are associated with severe bladder inflammation, clinical symptoms, and treatment outcomes.