548 Foley catheter draining in the immediate post-injury phase is needed, but CIC should be begun as soon as feasible after that time [74–76]. When a child starts volitional voiding, CIC can be tapered and stopped as residual urines are measured and found to be insignificant (less that 5 ml). Urodynamics studies should be undertaken no earlier than 6 weeks after the injury, to allow for the manifestation of the extent of the neurologic injury [77]. Periodic reassessment of bladder and sphincter function is appropriate up to 2 years after the injury, due to the potential for change during that time. Renal ultrasonography should be part of the assessment, but voiding cystography is only needed when there are signs of potential risk (i.e. sphincter dyssynergy or poor detrusor compliance). Low detrusor filling and voiding pressures with complete emptying are the goal [78]. When this is not present during testing, starting or continuing CIC and adding anticholinergic medication is paramount to insuring the long-term health of the lower and upper urinary tract [79]. Conclusions Neurogenic bladder dysfunction in children takes in a very wide spectrum of conditions that include congenitally acquired conditions that may even be preventable today, conditions that are associated with specific anatomic abnormalities, and acquired conditions that may occur perinatally or from accidents or sports or motor vehicle related injuries. Despite the etiology, the guiding principles for management are similar; insuring and maintaining an adequate sized, normally compliant, reservoir that evac- uates urine completely, at a relatively low pressure, is the key to maintaining a healthy environment for the kidneys. A plethora of methods has come into existence, especially since the advent of clean intermittent catheterization and the advancement of pharmacologic understanding and manip- ulation. Future prospects look bright for affected children, with the overall health of the individual the most paramount goal to be achieved. Pediatr Nephrol (2008) 23:541–551 2. What percent of newborns with a myelomeningocele have a normal upper urinary appearance on ultrasound within the first month of life? a. 45% b. 60% c. 75% d. 90% e. 98% 3. Credé voiding is best avoided in which of the following conditions? a. The presence of vesicoureteral reflux with a severely denervated urethral sphincter b. The presence of vesicoureteral reflux with a fully innervated urethral sphincter c. A poorly compliant bladder with a low leak point pressure d. An overactive detrusor with a low leak point pressure e. A compliant bladder with a low leak point pressure 4. When considering an antireflux operation in a child with a myelomeningocele, treating which urodynam- ics parameter beforehand is thought to be most important for achieving a successful result? a. Poor compliance b. Presence of detrusor overactivity c. Both conditions noted above d. Neither condition noted above e. A high leak point pressure 5. All of the following may be an outward physical sign of an occult spinal dysraphism except a. A subcutaneous mass overlying the thoracic spine b. An asymmetric gluteal cleft c. A draining pilonidal dimple d. One leg slightly longer than the other e. Spinal scoliosis 6. The conus medullaris normally resides opposite which vertebral body at puberty? Questions Answers appear following the reference list. 1. Which vitamin plays a major role in the prevention of neural tube defects? a. Thoracic 11 level b. Thoracic 12 level c. Lumbar 1 level d. Lumbar 2 level e. Lumbar 3 level a. Niacin b. Riboflavin c. Folic acid d. B12 e. Carotene 7. Which of the following maternal factors may be responsible for sacral agenesis in a newborn child? a. Exposure to progestational agents early in the pregnancy