Ed 11 Chapter 143 : Functional Disorders of the Lower Urinary Tract in Children

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A 9-year-old female presents to the office with a chief complaint of daytime urinary incontinence. She denies dysuria, hematuria, or enuresis. She has never had a urinary tract infection (UTI) and there is no history of hydronephrosis. Her mother states that toilet-training occurred at 2 years of age and was “easy.” A clean-catch urinalysis has been obtained by her pediatrician and is completely normal. When characterizing the incontinence, she states that she completely soaks her clothes, necessitating a change in wardrobe. She denies urgency or frequency and otherwise voids every 2 to 3 hours during the day. She states that the episodes are often associated with laughing at a funny joke or movie. She denies any issues with constipation. Assuming physical examination and voiding diary are normal, which of the following would be a reasonable first-line treatment strategy?

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A 4-year-old female presents to the office with a chief complaint of labial adhesions, dysuria, daytime urinary incontinence, and recurrent UTIs. Her mother states that toilet-training was completed at 20 months and that there were no issues with this. Based on history and completed voiding diary, her elimination pattern is normal. Her mother states that during the past 3 months, however, she has noted that her underpants are damp and that this is often noted within a few minutes of the child having voided. They deny any urgency or frequency. She recently has been complaining of severe dysuria with two urinalyses (UAs) in the past 4 weeks demonstrating 5 to 10 white blood cells per high-power field (WBCs/hpf). Urine cultures have all been negative, and antibiotics have not helped with symptomatology. Physical examination reveals superficial labial adhesions with moderately erythematous external genitalia. Noninvasive urodynamics with pelvic ultrasound and uroflowmetry reveal a bell-shaped curve and an empty bladder with normal wall thickness. There is a small amount of fluid noted in the vagina. While the child climbs down off of the examining room table, there is involuntary leakage of urine. Repeat pelvic ultrasound reveals that the vaginal vault is empty. What is the most likely diagnosis?

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An 8-year-old male is brought in by his grandmother, who recently obtained guardianship due to parental divorce and the biological mother's recent untimely death. She states that his teachers have been complaining that for the last 4 months he spends most of his time in the restroom, asking to use the bathroom approximately every 15 minutes. He has had some occasional dysuria, but no hematuria or fevers. They deny any UTIs or daytime urinary incontinence. He has occasional constipation, but this is readily corrected with fruit juice and he generally has one soft, smooth bowel movement daily. He is generally able to sleep through the night without having to wake to void, and they deny enuresis. The element in the history that will most often be able to distinguish pollakiuria from overactive bladder (OAB) is:

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Lower urinary tract dysfunction is associated with which of the following?

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The purported mechanism of action for botulinum toxin in the treatment of children and adolescents with dysfunctional voiding is:

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A 4-year-old girl presents to your office with an 8-month history of recurrent UTIs, daytime urinary incontinence, urgency, dysuria and enuresis. Mother states that she refuses to wear pull-ups and will soak through underwear and clothes 1 to 2 times per week. She is also wet 7 out of 7 nights per week. Mother states that she will often “wait until the last minute” to void and is afraid of the toilets at school and so will often not void until she gets home. Mother does not think that daughter is constipated, but upon further questioning, she often has hard, large stools and will have a bowel movement once or twice a week. Urine cultures from her pediatrician's office reveal pansensitive Escherichia coli on three separate occasions in the last 2 months. A renal/bladder ultrasound demonstrates normal upper urinary tracts and a voiding cystourethrogram (VCUG) shows bilateral grade 2 VUR. Urinalysis in the office is negative. The best next step after the administration of antibiotic prophylaxis is:

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Which of the following organ systems is implicated in the pathogenesis of enuresis?

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An 8-year-old male presents to your office with his parents for consultation regarding treatment for primary nocturnal enuresis. Behavioral modification, desmopressin, and the enuresis alarm have failed. Which of the following parameters is the best predictor of response to treatment with desmopressin?

Ed 11 Chapter 143 : Functional Disorders of the Lower Urinary Tract in Children

Question 1 of 1

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Lower urinary tract dysfunction is associated with which of the following?

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The purported mechanism of action for botulinum toxin in the treatment of children and adolescents with dysfunctional voiding is:

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Which of the following organ systems is implicated in the pathogenesis of enuresis?

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