Enuresis and Voiding Dysfunction

Question 1

mean bladder capacity in children up to 14 years old

Answer 1

age + 2 (in years) x 30

Question 2

how to achieve conscious bladder control

Answer 2

awareness of bladder filling
cortical inhibition of reflex bladder contractions
ability to consciously tighten the external sphincter to prevent incontinence
normal bladder growth
motivation by child to stay dry

Question 3

what is the most common cause of daytime incontinence

Answer 3

overactive bladder (urge incontinence)
bladder bowel dysfunction

Question 4

treatment for overactive bladder

Answer 4

treat constipation and UTI
Kegel exercises
Anticholinergic therapy 
Oxybutynin chloride
alpha adrenergic blocker: promotes bladder neck relaxation

Question 5

What is Hinman Syndrome?

Answer 5

very serious but uncommon disorder involving failure of external sphincter to relax during voiding in children without neurologic abnormalities

Question 6

What is nocturnal enuresis?

Answer 6

occurrence of involuntary voiding at night after 5 years old

Question 7

Treatment for nocturnal enuresis

Answer 7

reassure the child and parents, avoid punitive measures that can affect psychological development
Restrict fluid intake to 2oz after 6 or 7pm, void at bedtime, avoid sugar and caffeine after 5pm

Question 8

What is the simplest initial measure for enuresis?

Answer 8

*Motivational therapy, star chart for dry nights

• Conditioning therapy: loud auditory or vibratory alarm attached to moisture sensor in underwater, alarm activates when voiding occurs and awakens children to void; most effective in older children
• self-hypnosis

Question 9

Pharmacologic therapies for enuresis?

Answer 9

Desmopressin acetate tablet dose of 0.2 to 0.6mg 2 hour before bedtime for 3 to 6 months
Fluid restriction at night
Therapy resistant: anticholinergic therapy Oxybutynin
3rd line: Imipramine

Question 10

When is ideal repair for hypospadias?

Answer 10

6-12 months

Question 11

Inability to retract prepuce

Answer 11

Phimosis

*becomes retractable by 3yo

Question 12

treatment for phimosis

Answer 12

corticosteroid ointment to the tip of foreskin 2x a day for 1 month

Question 13

occurs when foreskin is retracted proximal to the coronal sulcus and prepuce cannot be pulled back over glans

Answer 13

Paraphimosis

Question 14

treatment for paraphimosis

Answer 14

lubricate the foreskin, topical application of granulated sugar to reduce edema, injection of hyaluronidase

Question 15

refers toa penis that appears to be small

Answer 15

inconspicuous penis

Question 16

normally formed penis that is at least 2.5 SD below mean size

Answer 16

micropenis

Question 17

what are the causes of micropenis?

Answer 17

hormonal abnormality at 14 weeks of gestation
hypogonadotropic hypogonadism
hypergonadotropic hypogonadism
idiopathic micropenis

Question 18

most common cause of micropenis?

Answer 18

failure of hypothalamus to produce adequate amount of GRH (Kallman Syndrome)

Question 19

persistent penile erection at least 4 hours and beyond

Answer 19

Priapism

Question 20

most common cause of priapism in children

Answer 20

Sickle cell disease