Search Results (208)

Background/Objectives: Pediatric uroflowmetry is volume dependent, and low-volume voids can yield recordings that require repetition or cannot be interpreted confidently. To evaluate whether documented bladder volume-guided timing was associated with first-attempt pediatric uroflowmetry process adequacy in children undergoing evaluation for suspected non-neurogenic lower urinary tract dysfunction. Methods: This single-center retrospective workflow cohort included 110 toilet-trained children aged 5–12 years who underwent uroflowmetry for suspected non-neurogenic lower urinary tract dysfunction. The exposure was classified from contemporaneous pre-test documentation as bladder volume-guided timing (n = 55) or standard urge-based timing (n = 55). Expected bladder capacity (EBC) was calculated as (age + 1) × 30 mL. The primary process outcome was first-attempt voided volume ≥ 50% EBC. Repetition after an inadequate first attempt was treated as a deterministic workflow consequence rather than an independent endpoint. Analyses were observational and effect estimates were interpreted as associations. Results: Adequate first-attempt voided volume was documented in 50/55 children (90.9%) with bladder volume-guided timing and 39/55 (70.9%) with standard urge-based timing (unadjusted risk ratio 1.28, 95% confidence interval [CI] 1.06–1.55; Newcombe risk difference 20.0 percentage points, 95% CI 5.3–34.0). After adjustment for age, baseline urgency score, and time since last void, the association remained (adjusted risk ratio 1.27, 95% CI 1.06–1.53; p = 0.011), and the model converged without numerical warnings. Using the age-specific lowest acceptable voided volume, adequacy occurred in 53/55 children (96.4%) versus 46/55 (83.6%) (adjusted risk ratio 1.15, 95% CI 1.01–1.31; p = 0.040). Repetition after an inadequate first attempt occurred in 9.1% versus 29.1% and was treated as a direct consequence of primary-threshold failure; it was not tested independently. Workflow-time measures were exploratory. Conclusions: Documented bladder volume-guided timing was associated with greater first-attempt process adequacy. Adjustment for age, baseline urgency score, and time since last void did not materially change the estimate. The association was attenuated but remained directionally consistent when the age-specific lowest acceptable voided volume was used. Because the timing rule deliberately targeted the same volume construct as the primary outcome, this finding does not establish improved diagnostic accuracy, clinical decision making, or patient outcomes. Retrospective exposure classification and routine documentation further preclude causal interpretation. Documented bladder volume-guided timing was associated with higher first-attempt achievement of a prespecified voided-volume threshold than standard urge-based timing. Because the pathway targeted the same volume construct used to define the primary outcome and was non-randomized, these findings are interpreted as hypothesis-generating workflow data rather than evidence of improved diagnostic accuracy or downstream clinical benefit. Full article

Background: Urinary tract infections (UTIs) are a leading cause of morbidity in patients with chronic spinal cord injury (SCI). This study examined the incidence of first and recurrent symptomatic UTIs in patients with chronic SCI and explored clinical factors associated with infection risk, with particular attention to bladder management methods and structural urinary tract abnormalities. Methods: We conducted a longitudinal observational study including 297 patients with chronic SCI (≥5 years post-injury; 215 males, 82 females with a mean age of 49.1 ± 13.8 years). Participants underwent regular evaluations, including kidney ultrasounds, videourodynamic studies (VUDS), and effective renal plasma flow (ERPF) measurements. Symptomatic UTIs were strictly defined using clinical–microbiological criteria to exclude asymptomatic bacteriuria (ASB). Clinical outcomes were evaluated over a minimum 5-year follow-up period. Results: Average annual symptomatic UTI rates were 0.31 ± 0.37 (major), 0.46 ± 0.47 (minor), and 0.77 ± 0.64 (total) episodes per patient-year. Bladder management method significantly influenced UTI rates (p < 0.001), with the highest rates observed in patients with indwelling urethral catheters (IUC) (1.19 ± 0.71), followed by suprapubic cystostomy (SPC) (0.91 ± 0.54), clean intermittent catheterization (CIC; 0.59 ± 0.47), and reflex voiding (0.31 ± 0.36). Recurrence (≥2 episodes) occurred in 23.9% of patients with indwelling catheters, 26.9% with suprapubic cystostomy, 13.0% with CIC, and 7.5% with reflex voiding. Patients with indwelling urethral catheters had higher total UTI rates and a higher recurrence rate than those with suprapubic cystostomy (1.19 vs. 0.91 episodes per patient-year; recurrence 38.8% vs. 26.9%). Hydronephrosis (Adjusted OR = 4.78, 95% CI: 2.45–9.32, and p < 0.001), bladder wall trabeculation (Adjusted OR = 3.65, 95% CI: 1.92–6.94, and p < 0.001), and indwelling catheter use (IUC + SPC) (Adjusted OR = 3.41, 95% CI: 1.85–6.29, and p < 0.001) were independently associated with increased UTI risk. Conclusions: Indwelling catheter use and specific structural upper and lower urinary tract abnormalities were independently associated with an increased risk of symptomatic UTIs in chronic SCI. Prioritizing CIC, routine monitoring with imaging and urodynamics, and implementing targeted preventive strategies may help reduce infection burden and preserve renal function. Full article

Botulinum toxin, once known only as the cause of botulism, has become a versatile therapeutic agent whose use in children now extends across many medical and surgical specialties. This narrative review synthesises the clinical use of botulinum toxin in patients up to eighteen years of age. We describe its pharmacology, the non-interchangeable commercial preparations, and the weight-based dosing and safety principles specific to childhood, then examine its applications by organ system. Gastrointestinal uses include functional constipation and internal anal sphincter achalasia, persistent obstruction after surgery for Hirschsprung disease, anal fissure, and achalasia. Urological uses centre on neurogenic and idiopathic detrusor overactivity and on sphincter-directed injection for dysfunctional voiding. Neurological uses are dominated by cerebral palsy spasticity and, on considerably weaker evidence, dystonia, while head and neck uses include sialorrhoea, congenital muscular torticollis, and strabismus. We also address neonatal brachial plexus palsy together with hyperhidrosis and aesthetic use in adolescents. The evidence supporting these uses is markedly uneven. Randomised controlled trials exist for only a small number of paediatric indications, chiefly spasticity in cerebral palsy, neurogenic detrusor overactivity, and chronic sialorrhoea, whereas most remaining applications rest on observational cohorts, small case series, or extrapolation from adult practice, and we grade the certainty of evidence separately for every indication. Only a few indications are formally approved, and most remain off-label, though increasingly supported. Botulinum toxin is a reversible and generally safe adjunct, but rigorous paediatric trials are still needed. Full article

Thoracoabdominal aortic aneurysm (TAAA) is a complex vascular disorder involving both thoracic and abdominal segments of the aorta and remains associated with substantial morbidity and mortality. One of the most serious complications after thoracoabdominal aortic aneurysm (TAAA) repair is spinal cord ischemia (SCI), which may progress to spinal cord infarction and result in irreversible neurologic deficits including paraplegia, neurogenic bladder dysfunction, and bowel dysfunction. The incidence of SCI after TAAA repair varies with the extent of aneurysmal involvement, operative duration, and patient comorbidities. The primary pathophysiologic mechanism involves interruption of radiculomedullary arterial flow, compounded by systemic hypotension and limited collateral circulation. Because SCI profoundly affects functional recovery and long-term quality of life, prevention and early recognition are central to perioperative management. Established neuroprotective strategies emphasize maintenance of spinal cord perfusion through meticulous hemodynamic optimization, cerebrospinal fluid (CSF) drainage, and temperature modulation. Intraoperative neuromonitoring using motor and somatosensory-evoked potential facilitates early detection, while newer modalities such as near-infrared spectroscopy and CSF lactate monitoring may offer additional insight. When SCI occurs despite prophylaxis, rapid initiation of rescue measures including CSF drainage, hemodynamic augmentation, and other discussed treatments may improve neurologic outcomes. Long-term care focuses on rehabilitation, symptom management, and psychological support. Therefore, this review aims to consolidate medical evidence to improve the prevention, detection, and treatment of spinal cord infarction associated with thoracoabdominal aortic aneurysm repair. Full article

Background/Objectives: Spinal cord epidural stimulation (scES) holds significant potential for restoring autonomic function after chronic spinal cord injury (SCI). A significant and often debilitating sequela of SCI is neurogenic lower urinary tract dysfunction, characterized by loss of voluntary bladder control, which adversely impacts patients’ dignity, urological health, and overall quality of life. In a pilot study of three individuals with SCI, an epidural electrode array was implanted between L2 and sacral segments to modulate lower urinary tract function for efficient emptying. Methods: Three participants with chronic thoracic clinically complete SCI were implanted with an epidural stimulator over the lumbosacral spinal cord. Array placement was confirmed using intraoperative and postoperative spatiotemporal mapping of known motor neuron pools following published protocols. In a controlled laboratory mapping, bladder storage and voiding neural networks were targeted during filling cystometry by interactively optimizing lower urinary tract stimulation parameters (electrode configuration, frequency, intensity, and pulse width). Efficacy was assessed during six-hour laboratory sessions of natural bladder filling, followed by approximately four months of daily at-home use. Results: Pre-implant cystometry revealed poor voiding efficiency and absent bladder sensation. Following bladder scES mapping and home training, one of the three participants regained direct bladder sensation, exceeded the 90% clinical threshold for efficient voiding, and continues to use scES for bladder management instead of intermittent catheterization, with no urinary tract infections reported since completion of training (February 2022). The inability of two participants to attain high voiding efficiency may be due to suboptimal adherence to prescribed bladder training protocols in one case and the presence of an elevated bladder neck in the other. All three participants reported off-target improvements in bowel and sexual functions. Conclusions: The present novel pilot study provides the first evidence supporting the potential use of epidural stimulation for bladder management and the importance of activity-based recovery training for durable performance. Full article

Neurogenic bladder is a condition associated with impaired voiding, leading to urinary stasis and increased susceptibility to urinary tract infections, predominantly caused by Escherichia coli. In this context, bacterial iron acquisition systems represent attractive targets for alternative antimicrobial strategies. This study aimed to investigate the interactions of deferoxamine with E. coli iron acquisition proteins, combining an experimental model of neurogenic bladder with molecular analyses. The experimental model of neurogenic bladder was induced by complete spinal cord transection in rats, followed by urine collection by cystocentesis and microbiological characterization of uropathogens. Subsequently, molecular docking and energetic analyses were performed to evaluate the binding of deferoxamine and its Fe-DFO complex to the FhuE receptor of the ferric hydroxamate uptake pathway, with FhuA and FhuD prepared as correlated targets of the same pathway for structural context. The animals presented urinary retention and bacterial colonization, with E. coli identified as the pathogen. The results of the molecular docking revealed geometrically plausible accommodation of Fe-DFO within siderophore recognition pockets, involving residues associated with siderophore recognition and transport, as well as binding affinity scores consistent with weak-to-moderate structural complementarity compared to reference ligands. It is concluded that the neurogenic bladder model provides a biologically relevant framework for the study of urinary tract infections and that deferoxamine exhibits molecular interactions consistent with the ferric hydroxamate uptake system of E. coli. Because the present analysis was restricted to the Fhu pathway, these findings cannot be extrapolated to overall bacterial iron homeostasis, which involves multiple parallel acquisition systems. The current work is explicitly positioned as a proof-of-concept investigation; in vivo administration of DFO in the neurogenic bladder model, functional assays of iron uptake, transporter specificity experiments, and molecular dynamics analyses are identified as priority directions for future work. Full article

Exosomes, nanoscale extracellular vesicles released by virtually all cell types, have emerged as pivotal mediators of intercellular communication and play a crucial role in the pathophysiology of numerous acute and chronic diseases, including a wide spectrum of urological disorders. By acting as sophisticated biological shuttles, exosomes transport a rich and highly specific molecular cargo—comprising proteins, lipids, messenger RNAs, microRNAs, and other nucleic acids—that reflects the physiological or pathological state of their cell of origin. Owing to these unique properties, exosomes are increasingly recognized as promising biomarkers for the diagnosis, prognosis, and monitoring of a broad range of inflammatory, degenerative, and neoplastic diseases. Beyond their diagnostic value, exosomes have attracted considerable attention as therapeutic tools, given their ability to promote tissue regeneration, modulate immune responses, and serve as potential targeted drug-delivery systems for small molecules, biologics, vaccines, and gene-based therapies. Notably, exosomes recapitulate many of the beneficial biological effects traditionally attributed to stem cells, while potentially offering a more practical alternative. As cell-free entities, they may reduce—though not entirely eliminate—several risks associated with cell transplantation, such as uncontrolled proliferation and immune rejection, and they raise fewer ethical concerns, making them attractive candidates for regenerative and precision medicine. In urology, the diagnostic, prognostic, and therapeutic applications of exosomes are rapidly expanding, with particularly promising advances observed in bladder, prostate, and kidney diseases. Growing evidence also supports their relevance in a variety of benign urological conditions, including erectile dysfunction, male infertility, neurogenic bladder, urethral stricture disease, stress urinary incontinence, and bladder pain syndrome. This review synthesizes contemporary knowledge on the biological significance and clinical potential of exosomes in urology, highlighting their emerging role as biomarkers and therapeutics, with a special focus on benign urological disorders. We emphasize that the current evidence base in benign urology is largely preclinical, and that clinical translation, although promising, remains at an early stage. Full article

Background/Objectives: Testicular cancer (TC) is the most common solid malignancy in young males globally, yet population-level longitudinal data characterizing claims-based patient volume trends and co-occurring urological condition burden in South Korea remain limited. This study aimed to describe national trends in TC patient volume from 2020 to 2024, quantify exploratory associations with co-occurring urological and oncological conditions using aggregate annual counts, and generate exploratory 2026–2028 forecasts using validated statistical methods. Methods: We conducted a retrospective longitudinal analysis of administrative claims data from the Health Insurance Review and Assessment (HIRA) database of South Korea (2020–2024). Ten disease categories were analyzed: testicular cancer, bladder cancer, kidney cancer, prostate cancer, benign prostatic hyperplasia (BPH), chronic kidney disease (CKD), cystitis, neurogenic bladder, pyelonephritis, and carcinoma in situ. Annual patient counts, inpatient/outpatient utilization, and healthcare costs were extracted. Pearson and Spearman correlations were computed between TC and co-occurring condition volumes. Forecasting for 2026–2028 used a three-method ensemble: ARIMA(1,1,0), linear regression with 95% prediction intervals, and Holt–Winters exponential smoothing (weights: 0.35, 0.35, 0.30, respectively). The study was approved by the Institutional Review Board of Chungnam National University (IRB No. 202601-SB-014-01). All data were fully de-identified; informed consent was waived. Results: TC patient volume increased from 2309 in 2020 to 2992 in 2024 (compound annual growth rate [CAGR]: 6.69%). Exploratory ensemble forecasts projected 3287 (95% prediction interval [PI]: 2856–3540), 3767 (95% PI: 2962–3749), and 4531 (95% PI: 3066–3962) patients in 2026, 2027, and 2028, respectively, under a continued linear-trend assumption. TC patient volume showed strong positive exploratory correlations with CKD (r = 0.946, p < 0.05), prostate cancer (r = 0.945), kidney cancer (r = 0.932), BPH (r = 0.932), carcinoma in situ (r = 0.937), and bladder cancer (r = 0.928); given n = 5 annual observations, these reflect parallel secular trends and must not be interpreted causally. Nine of ten analyzed conditions demonstrated increasing trends; pyelonephritis showed a negative CAGR (−1.37%). Conclusions: TC patient volume in South Korea increased substantially over 2020–2024, with exploratory forecasts projecting continued growth through 2028. Parallel upward trends in co-occurring urological and oncological conditions are consistent with shared secular drivers including population ageing and improved detection, though individual-level causal inference is not possible from aggregate claims data. These findings support claims-based trend monitoring, urological oncology resource planning, and hypothesis generation for future individual-level studies. Full article

Background: Catheter-associated urinary tract infections (CAUTIs) are a major concern in patients with long-term indwelling urinary catheters, especially those with neurogenic bladder. This study assessed whether proactive cystoscopic removal of bladder debris reduces symptomatic UTI incidence and catheter blockage. Methods: This prospective, self-selected cohort study was conducted between January 2022 and December 2025 at a tertiary center in Taiwan. Enrollment occurred from January 2022 to June 2024, with follow-up completed by December 2025. Patients chose standard CDC-guided care (control, n = 63) or standard care plus flexible cystoscopy every 3 months for gentle low-volume evacuation (<100 mL normal saline) of dependent bladder debris (intervention, n = 141). Inverse probability of treatment weighting (IPTW) was used to address selection bias. Symptomatic UTIs were prospectively recorded using strict criteria. Cumulative incidence was analyzed with Kaplan–Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18–34). The incidence of catheter blockage was significantly lower in the intervention group (7.8% vs. 22.2%, p = 0.004). In the overall cohort, the reduction in symptomatic UTI incidence did not reach statistical significance (49.2% vs. 36.9%, p = 0.092). In the pre-specified spinal cord injury (SCI) subgroup (n = 71), the intervention was associated with improved UTI-free survival (log-rank p = 0.03; adjusted HR 0.52, 95% CI 0.28–0.96, p = 0.037; treatment × SCI interaction p = 0.042). All adverse events were Clavien–Dindo Grade I. No major complications occurred. Conclusions: Proactive gentle cystoscopic debris removal was associated with reduced catheter blockage. A signal toward lower symptomatic UTI risk was observed in the SCI subgroup, but not in the overall cohort. Due to the self-selected design and residual confounding, these findings are hypothesis-generating. Full article

Background: Pelvic floor dysfunction (PFD) is frequent in neurological disorders, but it is often approached as a secondary urological or gynecological problem rather than a functional rehabilitation target. Neurological disease can disturb cortical, pontine, spinal, sacral, autonomic, somatic, and sensory pathways that regulate bladder storage, voiding, bowel evacuation, sexual function, and pelvic pain modulation. Methods: This narrative review synthesized biomedical evidence identified through PubMed searches from database inception to 2 May 2026. Search concepts included neurogenic lower urinary tract dysfunction, urinary and bowel dysfunction, sexual dysfunction, pelvic pain, pelvic floor rehabilitation, biofeedback, electrical stimulation, neuromodulation, telerehabilitation, robotics, and major neurological disorders. The review was oriented according to the Scale for the Assessment of Narrative Review Articles (SANRA) and was not designed as a systematic review or meta-analysis. Results: Evidence from multiple sclerosis, stroke, Parkinson’s disease, Alzheimer’s disease and related dementias, spinal cord injury, and fibromyalgia or nociplastic pain syndromes supports a phenotype-based framework in which pelvic floor muscle training, bladder and bowel training, biofeedback, neuromuscular electrical stimulation, posterior tibial nerve stimulation, sacral neuromodulation, telerehabilitation, robotics, and multidisciplinary care are considered complementary rather than interchangeable strategies. Conclusions: PFD in neurological disorders may be more appropriately conceptualized as a multidimensional neurorehabilitation target. Effective care depends on disease-informed phenotyping, individualized rehabilitation goals, attention to cognition and adherence, and standardized outcome measurement. Future studies should test phenotype-specific pathways that integrate bladder, bowel, sexual, pain, participation, safety, and caregiver outcomes. Full article

Background: Myelomeningocele (MMC) is a severe neural tube defect resulting from primary neurulation failure. Despite advanced multidisciplinary paradigms, long-term morbidity remains substantial. Population-based longitudinal data from small European cohorts are scarce. This study evaluates long-term clinical and functional outcomes within a complete national cohort in Slovenia. Methods: A retrospective cohort study was conducted on all children born with MMC in Slovenia between 2007 and 2023. Patients were managed via a centralized, standardized multidisciplinary program. Phenotypic severity was stratified by anatomical lesion levels, and outcomes were assessed using standardized functional measures. Results: Over an 18-year period, 32 children were treated (prevalence: ~1 per 10,000 live births; mean follow-up: 13.2 years). All underwent anatomical closure within 24 h of birth. Hydrocephalus developed in 71.8% (n = 23), with 65.6% requiring ventriculoperitoneal shunting. Independent ambulation was achieved by 28.1%, while 46.8% were wheelchair-dependent and paraplegic. Neurogenic bladder dysfunction occurred in 87.5%. Subgroup analysis demonstrated that thoracolumbar lesions were significantly associated with lower ambulation rates and higher shunt dependency compared to lumbosacral lesions (p < 0.05). Long-term survival was 96.9%. Conclusions: This study represents the first comprehensive national analysis of myelomeningocele outcomes in Slovenia. Despite the relatively small number of patients, complete national coverage and centralized multidisciplinary management provide a unique overview of long-term outcomes. The findings demonstrate that outcomes achieved within the Slovenian healthcare system are comparable to those reported internationally, thereby establishing an important national benchmark for future evaluation of preventive measures and evolving treatment strategies. Full article

Progressive bladder fibrosis and impaired detrusor function represent converging pathological endpoints across diverse bladder disorders, including bladder outlet obstruction (BOO) associated with benign prostatic hyperplasia, spinal cord injury (SCI)-induced neurogenic bladder, radiation cystitis, and interstitial cystitis/bladder pain syndrome. Conventional therapies primarily manage symptoms and rarely reverse established fibrosis or restore durable bladder homeostasis. Mesenchymal stem/stromal cells (MSCs) have attracted considerable interest as therapeutic agents owing to their antifibrotic, immunomodulatory, angiogenic, and trophic paracrine activities. This review synthesises six key studies from our group and places them within the broader international literature on bladder regenerative medicine: (i) feasibility of superparamagnetic iron oxide (SPIO)-based molecular MRI tracking of transplanted human MSCs (hMSCs) in the bladder; (ii) SPIO-hMSC therapy for BOO-associated fibrosis with concurrent MRI monitoring; (iii) hepatocyte growth factor (HGF)-overexpressing engineered hMSC (B10.HGF) therapy in BOO; (iv) hMSC transplantation into the SCI-injured bladder wall monitored by MRI; (v) systematic review and meta-analysis of stem cell therapy effects on urodynamic outcomes in SCI models; and (vi) HGF-overexpressing hMSC therapy for BOO-induced underactive bladder. These six key studies are contextualised within the broader literature addressing cell sources, biomaterial-assisted delivery platforms, mechanistic pathways, emerging clinical evidence, and the evolving regulatory landscape for cell-based advanced therapy medicinal products. Key translational challenges include product standardisation, long-term durability, and mechanism-linked potency assay development. Full article

Background/Objectives: Variations in urinary symptom improvement after benign prostatic hyperplasia (BPH) surgery remain incompletely characterized. Preoperative factors, including bowel dysfunction, may influence postoperative recovery. We evaluated the association between baseline bowel function and urinary outcomes after holmium laser enucleation of the prostate (HoLEP), hypothesizing that worse baseline constipation would be associated with poorer outcomes. Methods: A prospective cohort study of patients undergoing HoLEP by a single surgeon at a high-volume center (December 2023–September 2024) was performed. Patients with neurogenic bladders, bowel disorders, or diabetes mellitus were excluded. Baseline bowel function was assessed using the Constipation Scoring System (CSS) and Vaizey Incontinence Score (VIS). The primary outcomes were 3-month changes in International Prostate Symptom Score (IPSS) and Michigan Incontinence Severity Index (MISI). Associations were evaluated using Spearman correlation and multivariable linear regression. Results: Among 102 patients (median age of 71.6 years), 81 (79.4%) completed follow-up. The median prostate size was 90.5 cc, and 50% had prior urinary retention. The baseline CSS and VIS were low. IPSS, quality of life, and MISI bother improved postoperatively, while MISI severity showed minimal change. Higher CSS correlated with higher VIS (p < 0.001). Baseline CSS and VIS were not associated with changes in IPSS, quality-of-life (QoL), or MISI bother. Baseline VIS was associated with modest improvement in MISI severity (β −1.14, p = 0.01). Conclusions: Baseline bowel function was not associated with urinary symptom improvement after HoLEP. However, preoperative fecal incontinence was associated with improvement in urinary incontinence severity. Full article

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement. Full article

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia’s congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment—disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb–trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration. Full article