The summary of this paper states that a “consensus statement is not a guideline nor a method with which to establish what is best practice. It is a way of surveying practice and providing a benchmark for others to compare their own practice and be reassured where there is a paucity of clinical evidence.” It is with this statement in mind that the British Association of Paediatric Urologists (BAPU) has over recent years undergone a series of consensus debates at its annual meeting in September, and come up with a number of consensus statements as a result. This is one of them. The article is a good summary of the dilemmas and some of the questions raised when treating children with a neuropathic bladder. The summary is as follows:
- Urodynamics tend to be reserved for children with a clinical indication. Yearly ultrasound scan (USS) should be performed on all.
- Clean intermittent catheterisation (CIC) is used either in all patients or only when there was evidence of poor bladder emptying, split 50:50 between practitioners.
- Prophylactic antibiotics when using CIC is not usual.
- Anticholinergics are not used routinely but when used, oxybutynin is the first-line treatment.
- Botulinum toxin A is used by many despite the paucity of paediatric literature evidence. The dose is weight related and often more than six treatments have been given.
- Ileocystoplasty is the most commonly offered surgical solution and is likely to remain so for the foreseeable future.
- Post augmentation cystoscopy surveillance begins about 10 years post surgery.
- DMSA scans are only performed if there is a clinical or radiological indication.