Paediatric Urology

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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S. Tekgül (Chair), H.S. Dogan, R. Kocvara, J.M. Nijman (Vice-chair), C. Radmayr, R. Stein
Guidelines Associates: M.S. Silay, S. Undre,, J. Quaedackers

1.INTRODUCTION

1.1.Aim

A collaborative working group consisting of members representing the European Society for Paediatric Urology (ESPU) and the European Association of Urology (EAU) has prepared these Guidelines with the aim of increasing the quality of care for children with urological conditions. This Guideline document addresses a number of common clinical pathologies in paediatric urological practice, as covering the entire field of paediatric urology in a single guideline document is unattainable.

The majority of urological clinical problems in children are distinct and in many ways differ to those in adults. This publication intends to outline a practical and preliminary approach to paediatric urological conditions. Complex and rare conditions that require special care with experienced doctors should be referred to designated centres where paediatric urology practice has been fully established and a multidisciplinary approach is available.

Over time, paediatric urology has informally developed and matured, establishing its diverse body of knowledge and expertise and may now be ready to distinguish itself from its parent specialties. Thus, paediatric urology has recently emerged in many European countries as a distinct subspecialty of both urology and paediatric surgery and presents a unique challenge in the sense that it covers a large area with many different schools of thought and a huge diversity in management.

Knowledge gained by increasing experience, new technological advances and non-invasive diagnostic screening modalities has had a profound influence on treatment modalities in paediatric urology, a trend that is likely to continue in the years to come.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of children and their care-givers into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The EAU-ESPU Paediatric Urology Guidelines Panel consists of an international group of clinicians with particular expertise in this area. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU Website Uroweb: http://uroweb.org/guideline/paediatric-urology/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text version. A number of translated versions, alongside several scientific publications in European Urology, the Associations scientific journal are also available [1-3]. All documents can be viewed through the EAU website: http://uroweb.org/guideline/paediatric-urology/.

1.4.Publication history

The Paediatric Urology Guidelines were first published in 2001. This 2017 publication includes a number of updated chapters and sections as detailed below.

1.5.Summary of changes

The literature for the complete document has been assessed and updated, wherever relevant.

Key changes in the 2017 publication:

  • Section 3.4 - Acute scrotum in children: The literature has been updated resulting in minor revisions to the text;
  • Section 3.5 - Hypospadias: Both the literature and the text have been revised extensively;
  • Section 3.6 - Congenital penile curvature: Both the literature and the text have been revised extensively;
  • 3.12 - Dilatation of the upper urinary tract (UUT) (UPJ and UVJ obstruction). A new section presenting the results of a systematic review interrogating the role of antibiotic prophylaxis in antenatal hydronephrosis has been included [4];
  • Section 3.14 - Urinary stone disease: Both the literature and the text have been revised extensively.

1.5.1.New and changed recommendations

3.6.4 Summary of evidence and recommendations for the management of congenital penile curvature

Summary of evidence

LE

Isolated congenital penile curvature is relatively uncommon.

2a

Congenital penile curvature is often associated with hypospadias.

2a

Diagnosis is usually made late in childhood.

2a

The penis only appears abnormal when erect.

1b

Congenital penile curvature can cause aesthetic as well as functional sexual problems.

1b

Congenital penile curvature is treated with surgery.

1b

The goal of surgery is to achieve corpora of similar size.

1b

Recommendations

LE

GR

Ensure that a thorough medical history is taken and a full clinical examination done to rule out associated anomalies in boys presenting with congenital curvature.

1a

A

Provide photo documentation of the erect penis from different angles as a prerequisite in the pre-operative evaluation.

1b

A

Perform surgery after weighing aesthetic as well as functional implications of the curvature.

2b

B

At the beginning as well as at the end of surgery perform artificial erection tests.

2a

A

3.5.6Summary of evidence and recommendations for the management of hypospadias

Summary of evidence

LE

Androgen stimulation therapy results in increased penile length and glans circumference.

1B

The complication rate is about 10% in distal and 25% in proximal hypospadias one-stage repairs. Higher and variable rate (between 28 and 68%) can occur in two-stage repairs.

3

Recommendations

GR

In children diagnosed with proximal hypospadias and a small appearing penis, reduced glans circumference or reduced urethral plate, pre-operative hormonal androgen stimulation treatment is an option and the body of evidence to accentuate its harms and benefits is inadequate.

B

Ensure long-term follow-up to detect urethral stricture, voiding dysfunctions and recurrent penile curvature.

A

Use validated objective scoring systems to assist in evaluating the functional and cosmetic outcome.

A

3.12.5 Summary of evidence and recommendations for the management of ureteropelvic junction (UPJ)-, UVJ-obstruction

Summary of evidence

LE

In children diagnosed with antenatal hydronephrosis, a systematic review could not establish any benefits or harms related to continuous antibiotic prophylaxis.

1b

In children diagnosed with antenatal hydronephrosis, non-circumcised infants (LE: 1a), children diagnosed with high-grade hydronephrosis (LE: 2) and hydroureteronephrosis (LE: 1b) were shown to be at higher risk of developing UTI.

2

Recommendation

LE

GR

Offer continuous antibiotic prophylaxis to the subgroup of children with antenatal hydronephrosis who are at high risk of developing urinary tract infection (uncircumcised infants (LE: 1a), children diagnosed with hydroureteronephrosis

(LE: 1b) and high-grade hydronephrosis (LE: 2).

2

A