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

Abstract

Prior to Publication, this guideline underwent review by the cua guidelines committee, exPert external reviewers, and the cua executive board. E338 INTRODUCTION AND BACKGROUNDNeurogenic lower urinary tract dysfunction (NLUTD) refers to abnormal function of the bladder, bladder neck, and/or sphincters associated with any neurologic disorder. 1 Congenital pediatric NLUTD is mainly caused by spinal dysraphism, commonly spina bifida (SB). 2 Pediatric NLUTD is increasingly prevalent in Canada. A populationbased study conducted in Canada (excluding Quebec) from 2004-2015 showed that there were 4.4 cases of neural tube defects (NTDs) per 10 000 total births; however, the prevalence of NTDs increased from 3.6 in 2004 to 4.6 per 10 000 in 2015. Specifically, SB was the only NTD subtype with an increasing prevalence over time. 3,4 Pediatric patients with NLUTD are at risk for recurrent urinary tract infections (UTI) and upper tract damage leading to chronic kidney disease, necessitating early detection and management. 2 In addition, advances in prenatal diagnosis of congenital spinal dysraphism in Canada enable early detection and prenatal intervention. 5,6 Managing the resultant pediatric NLUTD requires collaboration among various healthcare providers to ensure healthy long-term outcomes. Purpose and scopeThe Pediatric Urologists of Canada (PUC) and the Canadian Urological Association (CUA) collaborated to provide this guideline of evidence-based recommendations for the diagnosis, management, and treatment of pediatric patients with NLUTD. The target readers of this guideline include pediatric urologists, general urologists, pediatricians, and allied health professionals with the goal of optimizing care and achieving improved subpopulation health outcomes.The definition, terminology, and classification of NLUTD are described in prior CUA clinical practice guidelines on adult patients with NLUTD, 7 which were adapted from the International Continence Society (ICS). 8 For pediatric NLUTD-specific descriptions, we refer readers to the 2016 update report from the standardization committee of the International Children's Continence Society (ICCS). 9 Specifically, for this guideline, the definition for bladder hostility encompasses bladders that are considered high risk for urologic morbidity and is summarized in Table 1, with relevant additional definitions and terminology for pediatric NLUTD. METHODOLOGYThe CUA Guidelines Committee pre-approved the pediatric NLUTD guideline methodology, which uses the ADAPTE approach. The process included a critical appraisal of recent pediatric neurogenic bladder guidelines using AGREE II. 10,11 For the purpose of this guideline formulation, two licensed reference special-

The rationale for bladder washouts in children with neurogenic bladder

“…In comparison, only 8% would continue prophylaxis long‐term 17 . The 2023 guideline published by the Canadian Urological Association and the Paediatric Urologists of Canada recommended that antibiotic prophylaxis should be considered if neurogenic bladder patients have had recurrent or severe UTIs within the last 3–6 months or have had a history of symptomatic UTIs with catheter use 18 …”

“…17 The 2023 guideline published by the Canadian Urological Association and the Paediatric Urologists of Canada recommended that antibiotic prophylaxis should be considered if neurogenic bladder patients have had recurrent or severe UTIs within the last 3-6 months or have had a history of symptomatic UTIs with catheter use. 18 Multiple retrospective studies have found that bladder irrigation with gentamicin reduces the risk of developing UTIs. One study of 16 adult patients with neurogenic bladder and recurrent UTIs while performing CIC found that 87.5% of patients were UTI-free during the study, while the remaining two patients had a reduction of 50% in the frequency of their UTIs.…”