Guidelines

Paediatric Urology

1. INTRODUCTION

1.1. Aim

The European Association of Urology (EAU) Paediatric Urology Guidelines Panel 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 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 are also available [1-7]. 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 [8]. This 2021 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 2022 publication:

  • Section 3.11 - Monosymptomatic nocturnal enuresis – bedwetting: Both the literature and the text have been extensively updated;
  • Section 3.12 - Management of neurogenic bladder: Both the literature and the text have been updated;
  • Section 3.16 -Obstructive pathology of renal duplication: ureterocele and ectopic ureter: The literature has been updated resulting in minor amendments to the text;
  • Section 3.19 – Rare Conditions – A new section has been added to the section on bladder tumours on eosinophilic cystitis and nephrogenic adenoma.

3.19Recommendations for rare conditions in children

3.19.2Papillary tumours of the bladder in children and adolescents - Eosinophilic cystitis and Nephrogenic adenoma
3.19.2.9 Recommendations for papillary tumours of the bladder in children

Recommendations

LE

Strength rating

Have a high index of suspicion of eosinophilic cystitis (EC) in protracted urinary tract symptoms unresponsive to regular treatment.

4

Strong

Remove any possible allergens as the obvious first step in managing EC.

4

Strong

Eosinophilic cystitis can be managed medically with corticosteroids, antibiotics, anticholinergics, and antihistamines, in addition to cyclosporine A.

4

Weak

Manage nephrogenic adenoma (NE) by resection either transuretherally or by open excision.

4

Strong

Regular endoscopic follow-up especially for augmented patients with NA is justified.

4

Weak