A multinational survey on the management of the urinary tract in newborns with spina bifida: Are we following current EAU/ESPU guidelines?

Abstract

In August 2019, the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) published updated guidelines on the management of neurogenic bladder in children and adolescents. Our study aimed to establish whether members of the ESPU are adhering to these guidelines. Methods:We designed a survey comprising 26 questions using SurveyMonkey®.Respondents were asked about management of neurogenic bladder at birth in newborns with spina bifida (SB), urological investigations, as well as short and long-term follow-up in their institutions. Results: There were 103 respondents to the survey (754 recipients, giving a response rate of 14%) spanning 36 countries. 100% of respondents carry out a renal/bladder ultrasound at birth. Only 53% routinely commence clean intermittent catheterization soon after birth as recommended by the guidelines. Only 56% recommend anticholinergic medications after abnormal videourodynamics (VUDs). The guidelines recommend the use of continued antibiotic prophylaxis if there is evidence of vesicoureteral reflux and hostile bladder/non-conclusive results on VUDs which is followed by only 30% of providers. 63% of respondents carry out baseline VUDs at the recommended time. Seeing larger volumes of SB patients, having a formal SB protocol, having formal SB multidisciplinary clinics and working in a tertiary referral center did not make respondents more likely to adhere to guidelines. Conclusions: Our survey demonstrated that large variations from the EAU/ ESPU guidelines exist in practice. The study confirms that further work is required across institutions and countries to implement these evidence-based recommendations for standardized practice.

Importance of Regular Examination and Follow-up in Pediatric Patients with Neurogenic Bladder: 24-Month Follow-up Study Using a Japanese Health Insurance Database

“…Several factors like the general condition of the child, the specific pathology, and cooperation in performing investigations are taken into account when deciding the frequency of specific invasive assessments in real-world pediatric urology practice. Indeed, an online survey of the European Society for Paediatric Urology (ESPU) members found similar trends in the follow-up of patients with spina bifida, with tests such as urodynamic studies not being repeated sufficiently as recommended by the European Association of Urology (EAU)/ ESPU guidelines [ 12 ].…”

Multidisciplinary Management of Children with Occult Spinal Dysraphism: A Comprehensive Journey from Birth to Adulthood

“…Moreover, whereas the role of UDS is undoubtful in managing OSD [ 25 ] and suggesting surgery or second operations in late deterioration, urodynamic measurements in children vary widely among pediatric urologists. The interpretation of uroflow curves in children should be cautioned due to possible artifacts secondary to anxiety and the poor cooperation of many of these patients [ 27 ]. Analyzing such results in the context of a multidisciplinary team could increase the value of USD results, considering these results as a part of a broader spectrum of diseases that involve the central nervous system and skeletal.…”

Diagnosis and Treatment of Japanese Children with Neurogenic Bladder: Analysis of Data from a National Health Insurance Database

“…However, this finding is not surprising as guidelines are often not followed in real-world scenarios. Indeed, Kane et al showed that European Society for Pediatric Urology (ESPU) members had large variations in clinical practice compared with recommendations by the European Association of Urology (EAU)/ESPU for the management of neurogenic bladder in children and adolescents [8,17]. In their online survey, Kane et al included 103 ESPU members from 36 European countries [17].…”

“…Indeed, Kane et al showed that European Society for Pediatric Urology (ESPU) members had large variations in clinical practice compared with recommendations by the European Association of Urology (EAU)/ESPU for the management of neurogenic bladder in children and adolescents [8,17]. In their online survey, Kane et al included 103 ESPU members from 36 European countries [17]. During the initial inpatient stay of a newborn with spina bifida, all (100%) respondents carried out renal/ bladder ultrasound; however, 48% did a micturating/voiding cystourethrogram, 44% completed bladder volume measurements, while only 17% did videourodynamics.…”

“…During the initial inpatient stay of a newborn with spina bifida, all (100%) respondents carried out renal/ bladder ultrasound; however, 48% did a micturating/voiding cystourethrogram, 44% completed bladder volume measurements, while only 17% did videourodynamics. Their results should be evaluated in the light of the facts that most (80%) respondents of the survey were pediatric urologists and that the results of the survey may be affected by response bias as well as recall bias [17].…”