Acute kidney injury and metabolic derangements are common after extracorporeal membrane oxygenation (ECMO), yet their potential contribution to urinary stone formation is rarely described. Critically ill patients may develop lithogenic conditions related to tubular injury, oliguria, prolonged immobilization, catabolism, infection, and alterations in urinary solute handling. We report the case of a 13-year-old girl with B-cell acute lymphoblastic leukemia undergoing induction chemotherapy who developed Pseudomonas septic shock requiring prolonged extracorporeal support with venoarterial ECMO followed by venovenous ECMO. Her course was further complicated by acute respiratory distress syndrome, bilateral pneumothoraces, and prolonged intensive care unit hospitalization. During recovery, computed tomography revealed bilateral renal and ureteral calculi with moderate left hydroureteronephrosis. Despite significant stone burden, the patient remained clinically stable without urinary tract infection, preserved renal function, and gradual radiographic improvement. Because of ongoing chemotherapy, immunosuppression, pulmonary risk, and fluctuating procedural candidacy, management required repeated multidisciplinary reassessment involving pediatric urology, oncology, pulmonology, nephrology, and the patient's family. Initial decompression and staged ureteroscopic intervention were considered; however, serial imaging demonstrated partial spontaneous migration of calculi, allowing temporary conservative management with tamsulosin and close surveillance. Persistent left-sided impaction and limited further migration ultimately supported definitive bilateral ureteroscopy with laser lithotripsy and short-term stenting once medically optimized. This case highlights the complex balance between surgical urgency and systemic risk in post-ECMO patients with urolithiasis. It also raises the possibility that ECMO-related renal injury and critical illness physiology may contribute to the formation of low-density or matrix-type stones. Individualized multidisciplinary decision-making is essential in medically fragile patients.

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a rare and distressing condition characterized by unwanted genital arousal without associated sexual desire. While cases of PGAD/GPD in association with interstitial cystitis, urethritis, urinary tract infection, and urethral diverticulum have been described, bladder cancer has not yet been reported. To our knowledge, the present report describes the first known case of PGAD/GPD as the initial presentation of low-grade papillary urothelial carcinoma of the bladder in a young female.

Vesicovaginal reflux (VVR) is a functional voiding disorder characterized by the retrograde flow of urine into the vagina during micturition, often presenting with daytime incontinence or postvoid dribbling. It is commonly underrecognized and may be mistaken for anatomical abnormalities such as vesicovaginal fistula or obstructive hydrocolpos, which require surgical intervention. We report a case of an 8-year-old girl who presented with dysuria, urinary urgency, and fever. Transabdominal and transrectal ultrasounds revealed an anechoic area measuring 7.3 × 3.3 × 4.0 cm in the vagina while urinary bladder was filled, which disappeared after voiding. Pelvic magnetic resonance imaging showed a cystic fluid signal between the bladder and rectum that resolved following urination. Voiding cystourethrography ruled out filling defect, which suggested bladder-vaginal reflux. A literature search of PubMed and Google Scholar from 1972 to the present using the terms "urinary incontinence," "hydrocolpos," and "vesicovaginal reflux" identified 13 relevant articles. Including the present case, a total of 58 cases of VVR were reviewed, ranging from children to middle-aged adults. The diagnosis of VVR should be considered when transient fluid collection is observed in the vagina on ultrasound and disappears after complete voiding. Treatment focuses on behavioral therapy, including proper voiding posture and toileting habits, along with weight control when indicated.

Background and Objectives: Overactive bladder (OAB) is frequently associated with impaired quality of life and sleep disturbances, particularly in women with refractory symptoms. Non-invasive neuromodulation targeting autonomic regulation has emerged as a potential therapeutic approach. The purpose of this pilot trial is to assess the efficacy and safety of NESA non-invasive neuromodulation in the treatment of patients with overactive bladder. Materials and Methods: Triple-blind, randomized, sham-controlled pilot trial. Women ≥ 18 years with refractory OAB were randomized to active NESA or sham using an identical protocol (10 sessions, 60 min, twice weekly). Outcomes were collected at baseline, after session 5, and after session 10. The primary outcome was mean daily micturitions, assessed using a 3-day voiding diary. Secondary outcomes included other diary variables, urinary questionnaires (ICIQ-UI SF, ICIQ-QoL, B-SAQ), and sleep measures (PSQI, ISI). Results: Per-protocol analysis included 43 women (NESA n = 24; sham n = 19). At session 10, mean daily micturitions decreased from 9.19 to 8.07 with NESA and increased from 10.56 to 11.03 with sham (between-group p = 0.043; d = -0.97). Sleep improved with NESA versus sham (PSQI p = 0.001; d = -0.63; ISI p = 0.001; d = -0.59). Between-group differences in urinary symptom questionnaires were not significant. No device-related adverse events occurred. Conclusions: In this pilot trial, NESA neuromodulation was safe and showed preliminary signals of benefit, particularly for mean daily frequency and sleep outcomes. However, given the exploratory design, small sample size, and per-protocol analysis, these findings should be interpreted cautiously and confirmed in larger adequately powered trials before clinical implementation.