2023 Canadian Urological Association/Pediatric Urologists of Canada guideline: Pediatric patients with neurogenic lower urinary tract dysfunction

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The Canadian Urological Association (CUA) and the Pediatric Urologists of Canada (PUC) have collaborated on the development of an extensive clinical practice guideline (CPG) concerning pediatric neurogenic lower urinary tract dysfunction (NLUTD).This CPG is created using the ADAPTE method, incorporating AGREE II evaluation of existing CPGs [1][2][3][4][5][6][7] with de novo recent evidence search and appraisal; subsequently, the key recommendation statements were generated with a modified Delphi method involving the PUC members.[8][9][10][11] The CPG aims to provide evidence-based recommendations tailored to pediatric urologists, clinicians, and allied healthcare professionals engaged in managing children afflicted with NLUTD.12,13 The scope encompasses children with various neurological conditions, such as spina bifida, spinal cord injury, and cerebral palsy, among others, who suffer from urinary dysfunction.Specifically, for this CPG, the definition of bladder hostility encompasses bladders that are considered high risk for urological morbidity, and are summarized in Table 1, with additional relevant definitions and terminology for pediatric NLUTD. DIAGNOSIS AND EVALUATIONThe guideline emphasizes the importance of antenatal, postnatal management, and a multidisciplinary approach to diagnosis.Furthermore, the guideline addresses the significance of history-taking, physical examination, and imaging studies, such as renal and bladder ultrasonography, video-urodynamic or urodynamic with voiding cystourethrography, in identifying structural abnormalities and upper urinary tract changes.Other diagnostic assessment of renal function is also discussed.Table 2 summarizes the investigations recommended for different age ranges in pediatric NLUTD. CONSERVATIVE MANAGEMENTConservative management plays a pivotal role in the care of pediatric NLUTD patients.The guideline advocates for prompt intervention and emphasizes a proactive approach, such as early initiation of clean intermittent catheterization (CIC).Pharmacological interventions, such as anticholinergic medications, are presented as a valuable adjunct to conservative management.The guideline outlines the appropriate use of antibiotic prophylaxis and indications for anticholinergics and onatobotulinum A detrusor injection, as well as their potential side effects, and dosing strategies in pediatric NLUTD patients (Table 3).

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