A 1-year-old infant with myelomeningocele is found to have severe bilateral hydronephrosis and grade V vesicoureteral reflux on initial evaluation. Urodynamic studies show a hyperreflexic, high-pressure bladder with detrusor-sphincter dyssynergia. Medical management with anticholinergics is not well tolerated. Which of the following is an appropriate alternative management strategy in this infant?
A 10-year-old boy presents with severe flank pain and hematuria. A non-contrast CT scan reveals a 7mm calculus at the ureteropelvic junction. Metabolic evaluation reveals hypercalciuria. A 24-hour urine collection shows normal calcium levels but an elevated sodium excretion. What is the most likely impact of high dietary sodium on his stone-forming risk?
A 6-year-old girl presents with daytime urinary incontinence characterized by sudden, complete bladder emptying only when she giggles. She has no other voiding symptoms, and a physical exam and urinalysis are normal. Which of the following treatments has been shown to be most effective for this specific condition?
A 4-year-old boy with global developmental delay is having significant difficulty with toilet training. His parents note that he has frequent, large-volume daytime accidents but does not exhibit holding maneuvers or complain of urgency beforehand; he simply seems unaware until he is already wet. Failure to achieve which of the following physiologic milestones is the most likely primary deficit contributing to his incontinence?
A 15-year-old male presents with a painless left-sided scrotal mass that feels like a “bag of worms” on examination when he is standing. An ultrasound confirms a grade 3 varicocele and shows that the left testis is significantly smaller than the right. What is the most appropriate indication for surgical varicocelectomy in this patient?
A 14-year-old female presents with continuous urinary dribbling despite a normal pattern of voiding. She denies urgency or frequency. A renal ultrasound reveals a duplicated collecting system on the right side with hydronephrosis of the upper pole. Which of the following is the most likely diagnosis?
A 6-year-old boy with no daytime voiding symptoms is brought to the clinic for primary nocturnal enuresis. His father reports that he also wet the bed until he was 9 years old. The physical exam is normal. The parents are concerned and ask about the chances of him outgrowing this. What is the expected annual rate of spontaneous resolution for this condition?
A 9-year-old child with a history of augmentation enterocystoplasty for a neuropathic bladder presents with severe abdominal pain and signs of peritonitis. The family reports he missed his last two scheduled catheterizations. What is the most likely and life-threatening complication?
A 14-year-old male presents to the emergency department with 4 hours of severe, acute left testicular pain and swelling. On exam, the left testis is high-riding, exquisitely tender, and the cremasteric reflex is absent. What is the underlying anatomical abnormality that predisposes him to this condition?
An 8-year-old boy is diagnosed with grade 3 renal trauma after a fall from his bicycle. A CT scan shows a 2 cm renal laceration without urinary extravasation and a contained perirenal hematoma. He is hemodynamically stable. What is the most appropriate management for this major renal injury?
