Summary of the International Children's Continence Society Recommendations for the Diagnostic Evaluation and Follow-Up of Congenital Neurogenic Bladder

Question 1

Clinical vignette: You are treating a 10-month-old male patient with a high risk for spinal cord tethering.
Multiple Choice:
A) Schedule ultrasonography every 12 months
B) Schedule ultrasonography every 6 months
C) Schedule UDS every 6 months
D) No need for routine diagnostic evaluation

Answer 1

Correct answer: B
Explanation: According to Table 34.3, for newborns to toddlers with a high risk for tethering due to rapid growth, ultrasonography should be scheduled every 6 months until 2 years of age.
Memory Tool: “Newborns to Toddlers, 6 to 2—Half-year scans until they’re two!”
Reference Citation: Paragraph 1, Table 34.3
Why This Information is Important: Accurate diagnostic evaluation is crucial for the early detection and management of potential urologic complications associated with spinal cord tethering.

Question 2

Clinical vignette: You have a 15-month-old patient who recently had a UTI.
Multiple Choice:
A) Perform UDS when indicated by a change in ambulation
B) Perform UDS every 6 months
C) Perform UDS every 12 months
D) UDS is not indicated for UTI

Answer 2

Correct answer: C
Explanation: According to Table 34.3, for newborns to toddlers, UDS should be performed every 12 months if UTIs or lower extremity changes are observed.
Memory Tool: “1 UTI? Time for 1 UDS per Year.”
Reference Citation: Paragraph 1, Table 34.3
Why This Information is Important: Proper timing of UDS is critical for diagnosing and managing UTIs in young children, as untreated UTIs can lead to kidney damage.

Question 3

Clinical vignette: You’re treating a 5-year-old patient who has slower growth and shows no sign of tethering.
Multiple Choice:
A) Perform ultrasonography every 6 months
B) Perform ultrasonography every 12 months
C) Perform ultrasonography every 12 to 24 months
D) Perform ultrasonography every 36 months

Answer 3

Correct answer: C
Explanation: According to Table 34.3, for toddlers to adolescents at low risk for tethering due to slower growth, ultrasonography should be scheduled every 12 to 24 months.
Memory Tool: “5 to 15, check yearly to bi-yearly.”
Reference Citation: Paragraph 2, Table 34.3
Why This Information is Important: Regular monitoring is essential for detecting any developmental abnormalities or complications that may arise during this period of substantial growth.

Question 4

Clinical vignette: A 9-year-old patient comes to you after experiencing their second febrile UTI in six months.
Multiple Choice:
A) Perform a DMSA renal scan immediately
B) Perform a DMSA renal scan only if recurrent UTIs continue
C) Perform a DMSA renal scan when indicated
D) DMSA renal scan is not indicated for UTIs

Answer 4

Correct answer: C
Explanation: According to Table 34.3, for toddlers to adolescents, a DMSA renal scan should be performed when indicated by conditions such as febrile UTIs.
Memory Tool: “Two febrile UTIs make a DMSA ‘When Indicated’ sign flash.”
Reference Citation: Paragraph 2, Table 34.3
Why This Information is Important: Timely DMSA renal scans can help in the early diagnosis and management of renal scarring, which is a risk in cases of febrile UTIs.

Question 5

Clinical vignette: A 17-year-old patient is experiencing new episodes of wetting after being continent for years.
Multiple Choice:
A) Perform UDS when indicated by a change in lower extremity function
B) Perform UDS every 12 months
C) Perform UDS when indicated by new wetting
D) UDS is not necessary unless UTIs are present

Answer 5

Correct answer: C
Explanation: According to Table 34.3, for adolescents to adults, UDS should be performed when indicated by developments like new wetting.
Memory Tool: “Teen troubles with wetting? Time for testing!”
Reference Citation: Paragraph 3, Table 34.3
Why This Information is Important: Sudden changes in urinary continence can indicate underlying issues that require immediate evaluation and intervention.

Question 6

Clinical vignette: A 19-year-old patient with slow growth and no signs of tethering comes for an evaluation.
Multiple Choice:
A) Perform ultrasonography every 6 months
B) Perform ultrasonography every 12 months
C) Perform ultrasonography every 24 months
D) Perform ultrasonography every 36 months

Answer 6

Correct answer: B
Explanation: Table 34.3 recommends that for adolescents to adults at low risk for tethering with slower growth, ultrasonography should be performed every 12 months. This frequency may decrease to every 24 months once the growth velocity has decreased.
Memory Tool: “Nineteen and clean? Scan yearly, if keen.”
Reference Citation: Paragraph 3, Table 34.3
Why This Information is Important: It ensures regular monitoring for the early detection of any potential urological issues.

Question 7

Clinical vignette: A 20-year-old patient reports frequent UTIs despite antibiotic treatment.
Multiple Choice:
A) Perform VCUG/RNC only when indicated by recurrent UTIs
B) Perform VCUG/RNC as a routine investigation for UTIs
C) Perform VCUG/RNC when indicated by a change in ambulation
D) VCUG/RNC is not indicated for UTIs

Answer 7

Correct answer: A
Explanation: According to Table 34.3, for adolescents to adults, VCUG/RNC should be performed when indicated by conditions like recurrent UTIs.
Memory Tool: “Twice or more? VCUG/RNC opens the door.”
Reference Citation: Paragraph 3, Table 34.3
Why This Information is Important: Recurrent UTIs could signify underlying anatomical or functional abnormalities that may require surgical intervention.

Question 8

Clinical vignette: A 35-year-old patient has no indications of tethering and shows no ongoing somatic growth.
Multiple Choice:
A) Perform ultrasonography every 12 months
B) Perform ultrasonography every 24 months
C) Perform ultrasonography every 36 months
D) Ultrasonography is not required

Answer 8

Correct answer: C
Explanation: Table 34.3 states that for adults at low risk for tethering without ongoing somatic growth, ultrasonography should be performed every 36 months.
Memory Tool: “Three for 30s; one scan for each decade.”
Reference Citation: Paragraph 4, Table 34.3
Why This Information is Important: It’s essential for long-term surveillance and timely intervention if complications arise.

Question 9

Clinical Vignette: A pregnant woman undergoes prenatal imaging and is informed that her fetus has no observable renal tissue. What is the prognosis?

A. Usually asymptomatic
B. Lethal in nearly 100% of cases
C. Hydronephrosis is common
D. Potential for nephrolithiasis

Answer 9

Correct Answer: B

Explanation: According to Table 38.1, bilateral renal agenesis is lethal in nearly 100% of cases due to pulmonary hypoplasia.

Memory Tool: “Bilateral = Bye” - Almost always lethal.

Reference: Table 38.1, paragraph on Bilateral renal agenesis.

Rationale: Knowing the prognosis of anomalies is crucial for counseling patients and making clinical decisions.

Question 10

Clinical Vignette: A young adult male undergoes routine imaging and is found to have only one kidney. What are the reproductive implications?

A. No impact on reproduction
B. Reproductive anomalies in 20% to 40%
C. Reproductive anomalies in approximately 15%
D. Increased risk for tumors unproven

Answer 10

Correct Answer: B

Explanation: Table 38.1 mentions that in cases of unilateral renal agenesis, reproductive anomalies occur in both sexes in 20% to 40%.

Memory Tool: “Unilateral, Unique reproductive issues” - 20% to 40% reproductive anomalies.

Reference: Table 38.1, paragraph on Unilateral renal agenesis.

Rationale: Understanding the broader systemic implications of a urologic condition aids in comprehensive patient management.

Question 11

Clinical Vignette: During surgery for an unrelated condition, a patient is discovered to have an extra kidney. Where is it likely to be located?

A. Cephalad to orthotopic kidney
B. Caudad to orthotopic kidney
C. On the contralateral side
D. In the thoracic cavity

Answer 11

Correct Answer: B

Explanation: According to Table 38.1, the majority of cases with supernumerary kidney have it caudad to the orthotopic kidney.

Memory Tool: “Super Caudad” - Extra kidney is likely below the normal one.

Reference: Table 38.1, paragraph on Supernumerary kidney.

Rationale: Knowing anatomical specifics assists surgeons and radiologists in diagnosis and treatment.

Question 12

Clinical Vignette: A child presents with repeated UTIs. Imaging reveals a kidney that has not fully ascended. What other anomaly is likely to be found?

A. Anorectal malformations
B. Reproductive anomalies in approximately 15%
C. Genitourinary malformations
D. Clubfeet

Answer 12

Correct Answer: B

Explanation: Table 38.1 specifies that in simple renal ectopia, reproductive anomalies occur in both sexes in approximately 15%.

Memory Tool: “Simple Repro” - 15% have reproductive anomalies in Simple Renal Ectopia.

Reference: Table 38.1, paragraph on Simple renal ectopia.

Rationale: Being aware of associated conditions aids in the holistic management of the patient.

Question 13

Clinical Vignette: An infant is diagnosed with a horseshoe kidney. What genetic syndrome should also be evaluated?

A. Turner syndrome
B. VACTERL
C. Potters facies
D. Clubfeet

Answer 13

Correct Answer: A

Explanation: According to Table 38.1, horseshoe kidney is associated with Turner syndrome.

Memory Tool: “HorseTurn” - Horseshoe kidneys are connected with Turner syndrome.

Reference: Table 38.1, paragraph on Horseshoe kidney.

Rationale: Identifying genetic syndromes connected to urological abnormalities facilitates multidisciplinary care.

Question 14

What is VACTERL?

Answer 14

VACTERL stands for Vertebral anomalies, Anal atresia, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities.

Question 15

Clinical Vignette: During prenatal ultrasound, a fetus is found to have a kidney on the opposite side of its ureter’s insertion into the bladder. What other condition should be evaluated?

A. Anorectal malformations
B. Genitourinary malformations
C. Reproductive anomalies in approximately 15%
D. Turner syndrome

Answer 15

Correct Answer: B

Explanation: According to Table 38.1, crossed renal ectopia is associated with genitourinary malformations.

Memory Tool: “Crossed over to the GU side” - Genitourinary malformations are associated with crossed renal ectopia.

Reference: Table 38.1, paragraph on Crossed renal ectopia.

Rationale: Recognizing other potential anomalies in prenatal diagnostics allows for early intervention and multi-disciplinary approach to care.

Question 16

Clinical Vignette: A patient who underwent thoracic imaging for a pulmonary issue is found to have a thoracic kidney. What is the most likely symptom?

A. Nephrolithiasis
B. Hydronephrosis
C. Usually asymptomatic
D. Reproductive anomalies

Answer 16

Correct Answer: C

Explanation: Table 38.1 states that thoracic kidneys are usually asymptomatic and are often discovered incidentally.

Memory Tool: “Thoracic Thumbs Up” - Usually no symptoms, a thumbs-up case!

Reference: Table 38.1, paragraph on Thoracic kidney.

Rationale: Awareness of incidental findings in imaging studies is crucial for avoiding unnecessary interventions.