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Intravesical injection of botulinum toxin-A has been shown to provide effective treatment for patients with detrusor overactivity refractory to first-line treatment with anticholinergics. In this Review, the authors discuss the currently available data regarding repeated injections of botulinum toxin-A to patients with neurogenic and idiopathic detrusor overactivity, and consider the efficacy and clinical considerations of this treatment modality.

The comparative efficacy of drugs for the management of overactive bladder syndrome (OAB) remains undefined. A new indirect treatment comparison demonstrates similar efficacy of mirabegron versus several antimuscarinic drugs and onabotulinum toxin A in a number of outcome measures. Head-to-head trials of these agents are still required to optimize the management of patients with OAB.

In this Case Study, Sahai and colleagues report on a 15-year-old boy who sustained grade V renal trauma, with associated splenic injury and renal vein thrombosis. The authors use the case to illustrate that conservative management of grade V blunt renal trauma is possible in a hemodynamically stable patient.

What is the optimum technique for delivering botulinum toxin to the bladder? Injection techniques vary worldwide and are unstandardized, and there is no consensus regarding whether technique actually matters. Most specialists believe that location and depth of injection is unlikely to alter efficacy, but studies have both confirmed and disputed these opinions.

Where anticholinergic therapy fails for overactive bladder and detrusor overactivity, botulinum toxin can be an excellent alternative. Data on this therapy's mechanisms of action, optimum delivery techniques and indications are, however, still unclear. This Review discusses these issues, mainly in relation to neurogenic and idiopathic detrusor overactivity but also with new therapeutic directions in mind.

Despite the high prevalence of overactive bladder (OAB) syndrome, its pathophysiology remains poorly understood. Twin studies offer a unique opportunity for studying the genetics of this disorder, but trials are limited by heterogeneous patient populations. Improved understanding of genetic factors in OAB will be vital to developing targeted management.

Across health care, clinicians are increasingly using patient-reported outcome measures (PROMs) to give a voice to patients and to help standardize the assessment of patients for comparison purposes. With this increasing use, the limitations of these PROMs should not be underestimated within the diverse population that we treat.

Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture has a reported prevalence of up to 10%, and such strictures have serious consequences that can lead to loss of kidney function and infectious complications. Here, the authors discuss the pathophysiology, diagnosis, risk factors, and management of ureteroenteric anastomotic strictures and describe ways in which stricture risk can be minimized.

Focus on quality of life after prostate cancer is vital to improve patient care. Improved assessment and proactive management of post-treatment functional outcomes is essential. Many aspects of the patients’ aftercare need to be improved in order to set up a clear path following prostatectomy. These improvements will enable a timely and efficient escalation of treatment and ameliorate patients’ survivorship experience.

In this Review, the authors describe the pathogenesis of uncomplicated urinary tract infections (UTIs). They discuss the need for nonantibiotic treatments and explore the nonantibiotic management options for the prevention and management of recurrent UTI.