Paediatric Urology

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

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C. Radmayr (Chair), G. Bogaert, H.S. Dogan, R. Kočvara, J.M. Nijman (Vice-chair), R. Stein, S. Tekgül
Guidelines Associates: L.A. 't Hoen, J. Quaedackers, M.S. Silay, S. Undre

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 is limited to 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 specialised 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 team is available.

Over time, paediatric urology has 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 caregivers 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: http://uroweb.org/guideline/paediatric-urology/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and as an app for iOS and Android 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 [4]. This 2019 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 2019 publication:


  • Section 3.5 – Hypospadias: Both the literature and the text have been updated;
  • Section 3.7 - Varicocele in children and adolescents: The summary of evidence table and the level of evidence in a recommendation have been updated following the outcome of a systematic review by the Panel;
  • Section 3.13 - Vesicoureteric reflux: Both the literature and text have been updated;
  • Section 3.14 - Urinary stone disease: The literature has been updated resulting in minor amendments to the text;
  • Section 3.16 - Disorders of sex development: The text has been revised extensively;
  • Section 3.17 - Posterior urethral valves: Both the literature and the text have been updated.

1.5.1.New and changed recommendations


3.16.6 Recommendations for the management of disorders of sex development

Recommendations

Strength rating

Newborns with DSD conditions warrant a multidisciplinary team approach.

Strong

Refer children to experienced centres where neonatology, paediatric endocrinology, paediatric urology, child psychology and transition to adult care are guaranteed.

Strong

Do not delay diagnosis and treatment of any neonate presenting with ambiguous genitalia since salt-loss in a 46XX CAH girl can be fatal.

Strong